Retrosigmoid approach with facial nerve preservation
In this new case available in the online surgery app SurgSchool, we present the surgery for vestibular Schwannoma of Koos IV angle performed by the Dr. Fernando Muñoz, neurosurgeon, Head of the Joint Neurosurgery Service at Sant Pau Hospital – Hospital del Mar in Barcelona and President of the Spanish Skull Base Society (SEBAC), Together with Dr. César Orús, Head of the Otology Department at Sant Pau Hospital.
The patient, a 62-year-old male, presented with a Vestibular schwannoma of the cerebellopontine angle, Koos classification IV, with progressive tumor growth and clinical instability and hearing loss.
Surgical technique
The procedure was carried out by means of a retrosigmoid approach, with initial emptying of cisterns and exposure of the cerebellopontine angle. It was performed tumor debulking to reduce volume and allow safer dissection of neurovascular structures.
Subsequently, the milling of the internal auditory canal, opening of the dura mater and localization of the Facial nerve, which was continuously monitored at low intensity. The resection was intentional subtotal, leaving a thin layer of tumor attached to the facial nerve to preserve its functional integrity.
Postoperative results
Follow-up MRI showed virtually complete resection with no evidence of significant residual disease. The patient progressed with initial grade IV facial paralysis, which progressively improved until degree II, maintaining ipsilateral cophosis and recovering a normal functional life.
Relevance for surgical training
This case is an example of the multidisciplinary skull base surgery, in which the collaboration between neurosurgery y Otolaryngology (lateral skull base / otoneurosurgery) It is essential to maximize tumor resection and preserve neurological function.
The participation of Dr. Muñoz and the Dr. Orús, international references in the management of cerebellopontine angle pathology, provides great educational value to the surgical community.
