Mediterr J Otol 2005:1(1):1-7.

Cerebellopontine angle surgery by retrosigmoid approach : Our experience in the elderly population.

Magnan J., Deveze A., Myazaki H., Canani FB.

ENT Department – North University Hospital, Chemin des Bourrelly, 13915  Marseille, France. jmagnan@ap-hm.fr

OBJECTIVES: We retrospectively evaluated the clinical results and peri- and postoperative complications of otoneurosurgical procedures by the retrosigmoid approach performed in a series of patients aged 70 or over.

PATIENTS AND METHODS: From January 1993 to January 2004, 111 consecutive patients (age range 70 to 83 years) underwent surgery with the use of the retrosigmoid approach for trigeminal neuralgia (n=36), hemifacial spasms (n=35), Ménière’s disease (n=13), tinnitus (n=2), and tumors of the cerebellopontine angle (CPA) (n=26). One patient with Ménière’s disease also had an asymptomatic meningioma of the CPA.

RESULTS: The time for complete recovery for hemifacial spasms was usually less than three months. Hemifacial spasms recurred in six patients after a mean of eight months, five of whom underwent revision surgery that was successful in three. The overall rate for complete recovery was 91.4%. For trigeminal neuralgia, recurrences or failure were encountered in eight patients, of whom four underwent revision surgery resulting in recovery in two, and significant improvement in one. The overall rates for complete relief and significant improvement were 66.7% and 19.4%, respectively. Problems arising from the otoneurosurgical procedures were relatively low, accounting for 13.8%. Mortality did not occur. Of 16 postoperative problems encountered in 15 patients, only six were life threatening. The most common problems were cerebrospinal fluid collection/ leakage (n=4), wound infection/inflammation (n=3), and deep venous thrombosis (n=3). None of these required revision surgery except for a wound infection.

CONCLUSION: As life expectancy increases, a growing number of elderly patients suffer from neurovascular conflicts and acoustic tumours which are associated with significant deterioration in quality of life. Our results show that minimally invasive retrosigmoid approach is a safe and efficient procedure, even for this fragile population. In this respect, documentation favoring the safety of the retrosigmoid approach may be encouraging for elderly patients in choosing surgical treatment to return to a more desirable level of living.