Indications
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The retrolabyrinthine approach is a hearing-preserving presigmoid approach that uses a mastoidectomy and skeletonization of the sigmoid sinus to expose the presigmoid dura behind the semicircular canals.
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The principal appeal of this approach is its ability to expose widely the posterior petrous face and cisternal portions of cranial nerves VII and VIII with a minimal degree of cerebellar retraction.
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The retrolabyrinthine approach additionally is used to identify and expose the superior petrosal sinus, as a first step for division of the tentorium.
Planning and positioning
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The patient generally is placed in a semilateral position on the operating table, with a bump under the ipsilateral shoulder.
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The head is placed in a Mayfield head holder with two pins placed in the occiput just off midline. The single pin is placed in the ipsilateral forehead, lateral to the mid-pupillary line ideally behind the hairline.
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After pinning, the head is usually positioned such that the region just behind the pinna just superior to the mastoid process is the highest point on the patient’s head. With adequate ipsilateral shoulder elevation, this position is achieved by a slight amount of contralateral head rotation, minimal neck flexion, and head elevation.
Figure 20-1:
Positioning for retrolabyrinthine approach.
Procedure
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