Avantages de l’abord rétro-labyrinthique pour l’exérèse des méningiomes insérés au pourtour du coude du sinus latéral

Abstract

To describe the retrolabyrinthine approach for the resection of 9 meningiomas inserted around the lateral sinus between the transverse and sigmoid parts, to discuss the value of this approach compared to the retrosigmoid approach for resection of meningioma in this localization and to review the literature. Retrospective study. Between 1988 and 2002, 9 patients (8 female, mean age 50 years) underwent surgery via the retrolabyrinthine approach for resection of meningiomas inserted around the lateral sinus between the transverse and sigmoid parts. Resection was total (8 Simpson I and 1 Simpson II) in all patients. In the early postoperative course, one patient was treated for meningitidis with an LCR leak and one patient present a temporary paresis of the vagus nerve. Mean follow-up was 5 years (6 months-10 years). All patients continued their pre-treatment occupation after surgery. No recurrence was observed. Two approaches can be used for resection of meningiomas in this localization. The retrosigmoid approach is a common neurosurgical approach exposure of the cerobellopontine angle. It is practised by most neurosurgeons. Via this approach, the cerebellar lobe must be pushed back so the arteries feeding the tumor are in the operative field at the end of the procedure. For numerous authors the operative field is too narrow. On the other hand, the retrolabyrinthine approach described in 1972 by Hitselberger and Pulec allows exposure of feeding arteries during the first steps of operation, an easier resection of meningioma insertion and better control of the lateral sinus. This approach can be enlarged to the retrosigmoid or the subtemporal anatomic region.