Translabyrinthine approach in acoustic neuroma surgery - case report

Abstract

Introduction. Acoustic neuroma is a benign tumor that arises from the glial Schwann sheath junction of the vestibulocochlear nerve. It has an incidence of 1:100000 population. Despite the fact that this is a rare tumor, it accounts for approximately 6% of all intracranial tumors and 80% of tumors localized in cerebellopontine angle. Treatment of acoustic neuroma is represented by "Wait and Scan" monitoring, radiologic and surgical treatment. The latter remains the primary treatment for acoustic neuroma and consists of 3 main approaches: retrosigmoid approach, middle cranial fossa approach and translabyrinthine approach. Until now, in our country, acoustic neuroma surgery was done only by retrosigmoid approach. Case presentation. The first translabirinthine surgery for acoustic neuroma in our country was done on 09.12.2021 on a 60-year-old patient who, during preparation for cochlear implant surgery, was accidentally diagnosed with 3rd grade right acoustic neuroma, according to Koos classification. Patient had cophosis on the right ear and moderate hearing loss in the left ear. During the surgery, a gross total resection of the tumor was accomplished. The patient was discharged from the medical institution on 20.12.2021 in a satisfactory condition. Magnetic resonance imaging performed 3 months and 1 year after the surgery showed no complications or tumor remnants. Conclusion. The current report, which describes an accidental diagnosis of acoustic neuroma during preparation for a cochlear implantation surgery, resulted in acoustic neuroma surgery through the translabyrinthine approach. This serves as an eloquent example of why it is necessary to perform initially a magnetic resonance examination in cases of sensorineural hearing loss or tinnitus. The translabyrinthine approach in acoustic neuroma surgery allows for the removal of tumors of any size without affecting the brain, especially the cerebellum. In our case, where the patient had cophosis on the side of the tumor, this was the most appropriate surgical approach.