A 45-year-old patient has a 3 cm acoustic neuroma (vestibular schwannoma) in the cerebellopontine angle with useful hearing (speech discrimination score >50%). The surgical approach that best preserves hearing is:

• A Translabyrinthine approach
• B Middle cranial fossa approach
• C Retrosigmoid (suboccipital) approach ✓
• D Combined transmastoid-middle fossa approach

Explanation

The retrosigmoid (posterior fossa/suboccipital) approach provides access to tumours of any size in the CPA while preserving the cochlea and Eustachian tube, offering a chance of hearing preservation in patients with residual serviceable hearing. The translabyrinthine approach sacrifices the labyrinth, guaranteeing deafness, but provides excellent facial nerve exposure. The middle cranial fossa approach is preferred for intracanalicular tumours with excellent preoperative hearing. For large CPA tumours with useful hearing, retrosigmoid is preferred.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.