Objective To report our technique and experience using a retrosigmoid
craniotomy approach for
auditory brainstem implantation (ABI) placement in adult
neurofibromatosis type 2 (NF2) patients. Design Retrospective case series. Setting Single-center study, Boston, Massachusetts, United States. Participants All NF2 patients who underwent evaluation at Massachusetts Eye and Ear Infirmary and surgery at Massachusetts General Hospital from 2009 to 2013 were reviewed. Six cases of retrosigmoid
craniotomy for ABI surgery in five adult NF2 patients were identified. The clinical history, operative course, and outcomes in these patients were reviewed. Main Outcome Measures Postoperative complications and audiological outcomes. Results Indications for ABI surgery were profound
hearing loss associated with growth or treatment of bilateral
vestibular schwannomas. In all cases, a retrosigmoid
craniotomy was performed for
tumor resection and ABI placement without complication.
Electrode placement was confirmed intraoperatively using electrical-evoked auditory brainstem responses. The ABI was activated in the awake patient 4 to 6 weeks postoperatively. Audiological testing was used to evaluate sound detection and speech perception with the ABI. There were no cases of
cerebrospinal fluid leak. Conclusion Retrosigmoid
craniotomy is a safe and effective means to provide access to the cochlear nucleus for ABI placement following
tumor resection in the adult NF2 patient. Preliminary data indicate that this approach has few complications while offering benefits for hearing. The retrosigmoid
craniotomy should be considered a reasonable alternative to the traditional translabyrinthine approach for placement of the ABI in deaf patients who are not candidates for the
cochlear implant.