Asian Super Specialty ENT Hospital offers the best retrosigmoid surgery in Visakhapatnam. A retrosigmoid surgery is performed to remove an acoustic neuroma originating from the nerve liable for balance and hearing.
Acoustic neuromas may cause hearing loss, vertigo, facial pain, dizziness, and ringing in the ears. The goals of surgery are:
- Maintaining facial nerve function
- Preserving hearing in the affected ear
- Removing the tumour
Asian ENT Hospital in Visakhapatnam is the only hospital in Andhra Pradesh that exclusively provides treatment for all the disorders and conditions of the ear, nose, throat, head, and neck.
Dr. Pradeep Vundavalli, our Medical Head, is a leading ENT doctor in Visakhapatnam and an expert in treating conditions of the ear, nose, throat, head, and neck medically or surgically.
Please continue reading to know about retrosigmoid surgery, its procedure, benefits, and more.
What is Retrosigmoid surgery?
Retrosigmoid surgery is also known as a suboccipital craniotomy. It involves removing a part of the occipital bone behind the ear to remove the tumour.
Surgeons can remove an acoustic neuroma by one of three different craniotomies: suboccipital, translabyrinthin, or middle fossa. The execution of a specific craniotomy depends on the tumour size, tumour position, and hearing status.
A craniotomy is making any bony opening into the skull. The section of the skull, termed a bone flap, is removed to access the brain underneath. After removing the tumour, the surgeon will place the bone flap back in its original position and secure it with plates and screws.
Who is an Ideal Candidate for Retrosigmoid Surgery?
You may be a good candidate for retrosigmoid surgery if you have:
- A medium or sizeable acoustic neuroma that is causing symptoms such as balance problems induced due to brainstem compression
- Neurofibromatosis type 2 (NF-2)
- Serviceable hearing in the affected ear
Who Performs Retrosigmoid Surgery?
- A neurosurgeon or neuro-otologist or otolaryngologist (ENT surgeon) can perform the retrosigmoid surgery.
- Each patient and each acoustic neuroma are different. Hence, it is important to seek treatment from a hospital-like Asian ENT that offers a complete range of services, including surgery, radiation, and hearing rehabilitation programs.
- Preventing or treating deafness in patients with NF-2 demands a team approach. Studies reveal that tumour size and the surgeon's experience are significant factors. These factors influence the facial nerve function and hearing outcome after tumour removal.
How is Retrosigmoid Surgery Performed?
There are six steps to the procedure. They usually take 4 to 6 hours, based on the tumour size.
Step 1: Preparing the Patient
First, your surgeon will administer anaesthesia. Once you are asleep, the surgeon will place your head in a 3-pin skull-fixation device attached to the table. It holds the head in proper position during surgery. The surgeon will shave the hair near the incision area. Then, clean the scalp with an antiseptic. Further, they will connect electrodes to your face and ear to observe the facial nerve, hearing, and brainstem functions during the procedure.
Step 2: Making an Incision in Your Skin
The minor and significant occipital nerves innervate the skin on the back of the head. These nerves can be incised, stretched, or trapped in scar tissue by incision. Chronic headache and occipital neuralgia may be related to the destruction of these nerves. A high-arching skin incision passes the nerves at their ends. It is less prone to cause harm. The muscles and skin are elevated off the bone and folded back.
Step 3: Perform a Craniotomy
A 1.5-inch-wide craniotomy is made in the occipital bone with a drill. The surgeon will remove the bone flap to expose the protective covering of the brain called the dura. Then, open the dura and fold back to expose the brain. Surgeons use retractors to hold back the cerebellum gently. These enable the surgeons to see the acoustic neuroma and the nerves.
Step 4: Debulk the Tumour
Based on the size, acoustic neuromas can attach to the facial nerve, trigeminal nerve, brainstem, and blood vessels. If the tumour is large, it is necessary to reduce its size. So, the surgeon has enough scope to see its attachments to nerves. The surgeon makes an incision in the tumour capsule, and then the centre is hollowed out. Surgeons use a drill to open the bony internal auditory canal to expose the origin of the tumour.
Step 5: Removing the Tumour
Your surgeon will cut the tumour origin at the vestibular nerve. And carefully dissect the facial nerve attachments. Any injury to the facial nerve causes facial weakness or paralysis. Surgeons make every effort to remove the tumour without damaging hearing, the facial nerve, and vital brainstem functions.
During tumour removal, the surgeons employ an evoked potential monitoring probe to stimulate and observe the nerves and brainstem. A reduction in nerve waveform signals the surgeon to stop the incision.
It may be beneficial to leave remnants of the tumour capsule connected to critical structures in some instances. It is called a near-total removal. Since these tumours grow gradually, the risk of recurrence is far less than damaging the nerves.
Step 6: Closing the Craniotomy
After removing the tumour, surgeons seal the internal auditory canal with bone wax and fix a small muscle over the opening. It prevents the cerebrospinal fluid (CSF) from leaking into the middle ear. The surgeon closes the dura in a watertight fashion and applies biological glue to avoid CSF leakage. Further, the bone flap is replaced and secured with titanium plates and screws. The skin and muscle incisions are re-joined and stitched together.
Advantages of the Retrosigmoid Surgery
- Retrosigmoid surgery can be conducted on all types of acoustic tumours and few other histologic tumours.
- Surgeons can use the retrosigmoid approach for operations for treating hearing loss and restoring hearing.
- It provides the best wide-field visualization of the posterior fossa.
- Hearing conservation surgery can be done even for relatively large tumours via the retrosigmoid approach.
Disadvantages of the Retrosigmoid Surgery
- Retrosigmoid surgery may require cerebellar retraction or resection.
- Manipulation of the cerebellum may cause postoperative bleeding, oedema, hematoma, and infarction.
- Cerebrospinal fluid leakage may occur in some instances.
- The retrosigmoid approach is associated with a greater probability of severe protracted postoperative headache.
- The risk of tumour recurrence or persistence occurs with retrosigmoid procedures.
Why choose Asian ENT Hospital for Retrosigmoid Surgery?
- Asian Superspecialty ENT hospital in Visakhapatnam is one stop in Andhra Pradesh for treatment of ears, nose, throat, neck, and head disorders and conditions.
- You will receive treatment from Dr. Pradeep Vundavalli. He is an experienced and skilled ENT specialist in Visakhapatnam.
- Our ENT specialists have the expertise and skills to handle advanced diagnostic, surgical, and therapeutic audiology procedures.
- Our ENT surgeons have achieved more than 98% surgical success rate.
- We maintain our service charges so that anyone can avail of our world-class treatments at affordable prices.
- Asian ENT Hospital has state-of-the-art medical infrastructure, high-quality result-oriented treatments, dedicated staff, and highly qualified doctors.
Please book an appointment with our ENT specialist in Visakhapatnam to seek the best suitable treatment for your ear, nose, throat, head, and neck problems.