Suboccipital retrosigmoid approach for resection of cerebellopontine angle tumor

This video shows a transotic approach for a cochlear schwannoma in a 59-year-old female who presented with sudden sensorineural hearing loss in her left three years prior. She was found to have subsequent growth of her tumor on imaging and elected to undergo surgery. The transotic approach is a valuable approach within the armamentarium of a skull base team and differs from the transcochlear approach in the handling of the facial nerve. Techniques for ear canal overclosure, eustachian tube packing and mastoid obliteration are also highlighted.

Authors:

Gavriel D. Kohlberg, MD – University of Cincinnati

Noga Lipschitz, MD – University of Cincinnati

Charlie Poff, BS – Medical University of South Carolina

Ravi N. Samy, MD, FACS – University of Cincinnati

A 31 year-old male presented with diplopia and was found to have left sixth nerve palsy on physical examination.  Work-up with MRI revealed a hypointense mass on T2 images involving the mid to lower clivus with penetration of the posterior fossa dura.  The patient had no complaints of nasal obstruction, no prior nasal surgery or nasal trauma.  Intraoperative frozen section analysis revealed chordoma.

Author Note: minute 3:41 “rostrum” was spelled incorrectly.

Contributor:

Eric Wang