To Abandon or Not Abandon: Antesigmoid Craniotomy with Retrolabyrinthine Vestibular Nerve Section

Increasing popularity of the retrosigmoid approach would have one believe this is the preferred posterior fossa approach for a vestibular nerve section. The authors take issue with this. The antesigmoid posterior lateral retrolabyrinthine approach is a gentle craniotomy, easily performed and with low morbidity. A review of 70 consecutive cases revealed no procedural alteration because of surgical exposure, an absence of meningitis, no VIIth nerve weakness, minimal headache, average hospital stay of five days, and only one patient with a significant CSF leak. Hyperventilation anesthesia, patience during delicate VIIIth nerve exposure, incorporation of abdominal fat into dural closure sutures and prophylactic antibiotics have made this operation easy for the patient…and the surgeon. Don't abandon it!