The Strategy of Facial Nerve Preservation in Acoustic Neuroma Surgery via Suboccipital Retrosigmoid Approach

Acoustic neuroma is a common intracranial tumor, with a prevalence of 80~90% in the lesions of cerebellopontine angle. Microsurgical removal remains its main therapy, and the retrosigmoid approach continues to be the most widely employed strategy for the surgical resection of acoustic neuromas, with preservation of facial nerve to be the important goal. In order to preserve the facial nerve, the facial nerve's function should be evaluated accurately before and after the operation. The course of the facial nerve and its variation in cerebellopontine cistern and internal auditory canal should be well understood. Adequate drilling of the posterior wall of the internal auditory canal is necessary. Sufficient decompression of intracranial pressure and the tumor is imperative. The principle of subperineural and bidirectionary dissection should be followed. The use of bipolar coagulation should decrease to the greatest extent, and facial nerve monitoring should be used throughout exposing and removal of the acoustic neuroma.