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Retrosigmoid Intradural Inframeatal Approach: Indications and Technique

Samii, Madjid MD, PhD.; Metwali, Hussam MSc; Samii, Amir MD, PhD.; Gerganov, Venelin MD, PhD

doi: 10.1227/NEU.0b013e3182889e59
Operative Technique

BACKGROUND: Surgery of lesions of the petrous apex involving the inframeatal/infralabyrinthine area is challenging and related to a high risk of complications. Various extensive skull-base approaches have been used.

OBJECTIVE: To present and evaluate our experience with a new hearing-preserving extension of the retrosigmoid approach to the inframeatal/infralabyrinthine area.

METHODS: The approach was used in 3 patients harboring lesions in the petrous apex with variable extension in the inframeatal/infralabyrinthine region. The surgical accessibility of the lesions offered by the approach, the completeness of tumor removal, and the outcome, in particular, the functional outcome and complication rate, were assessed.

RESULTS: The tumor could be resected from the target area in all cases. No approach-related complications occurred. Serviceable hearing and normal facial nerve functions were preserved in all cases.

CONCLUSION: Our initial experience with the retrosigmoid inframeatal approach showed that it provides sufficient access to the area and offers the possibility of complete tumor removal. It allows for hearing and facial nerve functional preservation. The approach is safe and related to a very low complication rate.

International Neuroscience Institute, Hanover, Germany

Correspondence: Hussam Metwali, MSc, International Neuroscience Institute, Rudolf-Pichlmayr-Straße 4D, 30625 Hanover, Germany. E-mail:

Received September 7, 2012

Accepted January 4, 2013

Copyright © by the Congress of Neurological Surgeons