Qualification of patients with CPA tumors to translabyrinthine approach based on own experiences

On the basis of the presented clinical material, the authors present their own observations concerning qualification of the patients with cerebello-pontine angle tumors for surgery utilizing the translabyrinthine approach. The clinical material includes 15 cases of stage II, III and IV cerebello-pontine angle tumors removed through translabyrinthine approach. In view of the fact that there are different opinions concerning the selection of appropriate surgical approach and of a conviction that translabyrinthine approach should be used in case of stage II, relatively small tumors, and that larger, stage III and IV ones should be operated on using the retromastoid approach, we are presenting our views concerning the qualification of patients. In our opinion, the translabyrinthine approach can be used for larger tumors--also for stage IV ones. The translabyrinthine approach was considered only in the cases with total hearing loss and not useful hearing. Of course, in the cases when the tumor penetrates into the middle cranial fossa or into the foramen magnum, the approach may prove rather difficult. As it has been known, the dimensions of the access route are determined by three main anatomical structures: altitude of the bulb of the internal jugular vein, location of the sigmoid sinus and the diameter of the internal auditory meatus. The fundamental advantages of the approach include: no cerebellum retraction required in the case of classic retromastoid approach, easy anatomical and neurophysiological identification of the course of the facial nerve and maintaining its continuity. An approach involving damage of internal ear structures can be performed only if the patient is deaf.