Robert K. Jackler, MD

Publication Details

  • Risk-benefit analysis of using the middle fossa approach for acoustic neuromas with > 10 mm cerebellopontine angle component LARYNGOSCOPE Satar, B., Jackler, R. K., Oghalai, J., Pitts, L. H., Yates, P. D. 2002; 112 (8): 1500-1506


    To evaluate hearing preservation and facial nerve (FN) outcome in the middle fossa (MF) approach for acoustic neuromas with a cerebellopontine angle (CPA) component >10 mm.Retrospective review of 193 patients.Patients were grouped according to tumor size: intracanalicular tumors (IC; 64), 1 to 9 mm CPA extension (42), and 10 to 18 mm CPA extension (47). Additionally, a group of 40 patients (tumor size 10-18 mm CPA extension) who had undergone a translabyrinthine (TL) approach was studied to assess comparative FN outcome. Hearing and FN function were measured 1 year postoperatively. We defined the success at functional hearing preservation as AAO-HNS class B or better and good FN outcome as House-Brackmann grade II or better.For IC tumors and those with up to 9-mm CPA extension, there was no significant difference in the rate of functional hearing preservation (62.2% vs. 63.1%, P =.931) and good FN outcome (93.7% vs. 97.6%, P =.358). For tumors of 10- to 18-mm CPA extension, the rate of hearing preservation (34%) was lower than the other groups (P =.006 and P =.009). In this group, the rate of good FN outcome was lower compared with the IC and 1- to 9-mm tumors (80.8% vs. 93.7%, P =.037 and 97.6%, P =.012). The rate of good FN outcome following the TL approach in a comparable cohort of patients was 100% (P =.003 in comparison with 10-18 mm tumor resected with the MF approach).When considering surgical options, patients with >10-mm tumors should be advised that choosing the MF approach for hearing preservation carries a somewhat higher risk of persistent FN dysfunction.

    View details for Web of Science ID 000177289300031

    View details for PubMedID 12172269

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