Dr. Jho's Retromastoid Craniectomy: Operation for Acoustic Neuroma, Meningioma, Epidermoid, Trigeminal Neuroma, Glossopharyngeal or Vagal Neuroma, Glomus Tumor, Trigeminal Neuralgia, Hemifacial Spasm, Vertigo, Tinnitus, Glossopharyngeal Neuralgia and Vertebrobasilar Aneurysm: Minimally Invasive Brain Surgery

Hae Dong Jho, M.D., Ph.D.

Minimally invasive "Band-aid" posterior fossa surgery for acoustic neuromas, meningiomas, epidermoids, trigeminal neuromas, glossopharyngeal or vagal neuromas, glomus tumors, trigeminal neuralgia, hemifacial spasm, vertigo, tinnitus, glossopharyngeal neuralgia and vertebrobasilar aneurysms

Facts About This Surgery

• Provides access for removal of acoustic tumors as well as other tumors at the cerebellopontine angle
• Provides access to the cranial nerves for surgical treatment of such problems as trigeminal neuralgia and hemifacial spasm
• Achieves this access through a two inch skin incision behind the ear

Discussion

This technique involves a small hole in the skull through a small incision. Retromastoid refers to the region behind the ear. This technique is ideal for removal of tumors such as acoustic neuromas, trigeminal neuromas, glossopharyngeal or vagal neuromas, glomus jugulare chemodectomas and other tumors located at the cerebellopontine angle. Combining delicate microsurgical skills with sophisticated electrophysiologic monitoring makes the chance of preserving hearing and facial nerve function very high in acoustic neuroma surgery. This approach is also utilized for surgical treatment of vertebrobasilar aneurysms and cranial nerve problems such as trigeminal neuralgia (tic doloreaux), and hemifacial spasm. The surgical incision requires only a small dressing and patients often only need to stay in the hospital for three to five days.

Images

            

Left: A preoperative MRI scan, axial view, reveals an acoustic tumor.

Right: A postoperative axial CT scan demonstrates complete resection of acoustic tumor accomplished via a retromastoid craniectomy.

            

Intraoperative magnified images during retromastoid craniectomy demonstrate complete removal of acoustic neurilemmoma.

Postoperative patient photographs demonstrate preservation of seventh cranial nerve function following retromastoid craniectomy for acoustic tumor removal. The patient's hearing was also well preserved.