Retrosigmoid approach to vestibular schwannomas

The treatment of vestibular schwannomas has evolved and changed. Depending on presenting symptoms, tumor size, and age of the patient, the options include observation, surgical resection, and radiosurgery. The surgical approaches include retrosigmoid, middle fossa, translabyrinthine, and transpetrous approaches or their combinations. Each approach has its own advantages and disadvantages. The selected approach, among other factors, depends on the patient's hearing status, the tumor size, and the surgeon's experience. The retrosigmoid approach is familiar to most neurosurgeons. It provides good exposure of the pertinent vascular and nervous tissues, while making hearing preservation possible.