Management of the Facial Nerve in Skull Base Surgery: Presigmoid Approach from Neurosurgeon’s Perspective

norosirurjiozel12-1-22kapak

Burak ÖZAYDINa,b, Abdullah KELEŞa, Mustafa K. BAŞKAYAa
aUniversity of Wisconsin, Madison School of Medicine and Public Health, Department of Neurological Surgery, Madison WI, United States
bUniversity of Wisconsin Madison School of Medicine and Public Health, Department of Surgery, Madison, WI, United States

Özaydın B, Keleş A, Başkaya MK. Management of the facial nerve in skull base surgery: Presigmoid approach from neurosurgeon’s perspective. In: Sanus GZ, Batıoğlu Karaaltın A, eds. Surgical Management of Facial Nerve Paralysis. 1st ed. Ankara: Türkiye Klinikleri; 2022. p.166-75.

Article Language: EN

ABSTRACT
Presigmoid approaches can be divided into retrolabyrinthine, translabyrinthine, and transotic approaches. Translabyrinthine approach is the most utilized presigmoid approach and the vestibular schwannoma surgery is the most common indication. Translabyrinthine approach provides direct view and early exposure to the internal acoustic canal. Early identification of facial nerve through the intracanalicular segment and in the brainstem is a major advantage of the translabyrinthine approach. Since it is not a hearing-preservation approach, it is almost exclusively utilized patients with non-serviceable hearing, although, some authors recommend using the translabyrinthine approach in tumors larger than 2 cm regardless of the hearing status due to low hearing-preservation rates in larger tumors. Neurosurgeons typically are not introduced to this approach during their training. Being proficient in labyrinthectomy with preservation of facial nerve requires extensive temporal bone dissection training. It is associated with less headache and cerebrospinal fluid leak complication rates compared to retrosigmoid approach.

Keywords: Facial nerve; neurosurgery; neurotology; skull base

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