Surgical strategy for communicating tumors in lateral skull base: pre-sigmoid sinus or retro-sigmoid sinus or combined approach?

Objective The surgical treatment for the communicating tumors in the lateral skull base usually affected intra-temporal and internal meatal canal (IAC) and cerebellopontine angle (CPA) is still challenge, and surgical approaches should be critical point.

Methods This study reviews the management and outcomes of 589 cases of communicating tumors in lateral skull base in our Department from 2001 to 2018. All patients underwent surgical treatments. A retrospective review chart for the surgical approach and clinical outcomes was performed.

Results Of totally 589 cases, 372 cases were diagnosed as acoustic neuroma, 108 Paraganglioma, 19 facial nerve neuroma, 6 ELST, 24 temporal bone GCT, 21 Langhan’s Histiocytosis X, 22 SACC and 17 carcinomas. Surgical removal was performed with pre-sigmoid sinus approach in 372 cases (63.2 %), retro in 140 (23.8 %) and combined approach in 77 (13 %). 401 cases (68.1 %) underwent complete resection, subtotal 134 (22.7 %) and partial 54 (9.2 %). No death occurred in all cases. 21 cases suffered from cerebrospinal fluid leakage after operation were cured by 7 underwent surgical revision and 14 conservative treatment.

Conclusion For communicating tumors in lateral skull base with aggressive in IAC and CPA , a combined approach of pre- and retro-sigmoid sinus is recommended for its clearer operation field and better protection of the structure and function of the cranial nerve.

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Publication History

Article published online:
10 June 2020