Name of the Procedure:

Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; combined with middle/posterior fossa craniotomy/craniectomy

Summary

In this complex surgical procedure, a section of the skull known as the bone flap is temporarily removed to gain access to the cerebellopontine angle (CPA) within the brain. This area is accessed transtemporally through the mastoid bone. The tumor located in the CPA is then excised. This procedure is often combined with craniotomy/craniectomy involving the middle or posterior fossa of the skull for broader access and thorough removal.

Purpose

The procedure addresses tumors located at the cerebellopontine angle, a region in the brain where the cerebellum and pons are closely situated. The goals are to remove the tumor, alleviate symptoms, and prevent further neurological damage.

Indications

• Presence of a tumor in the cerebellopontine angle
• Symptoms such as hearing loss, vertigo, balance issues, facial numbness or weakness
• Neurological deficits due to tumor compression
• Imaging studies (MRI/CT) confirming tumor diagnosis

Preparation

• Fasting for at least 8 hours before surgery
• Medication adjustments as advised by the physician
• Preoperative imaging studies (MRI/CT scans)
• Blood tests and other routine preoperative assessments
• Discussion of anesthesia plan with an anesthesiologist
• Signing of informed consent documents

Procedure Description

1. The patient is administered general anesthesia.
2. An incision is made behind the ear to access the mastoid bone.
3. The mastoid bone is drilled to expose the dura mater (brain covering).
4. A bone flap is removed to access the middle or posterior fossa regions.
5. The tumor is carefully excised using microsurgical techniques.
6. The dura mater is closed, and the bone flap is secured back in place, or a synthetic substitute is used if necessary.
7. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes between 4 to 12 hours, depending on the complexity and size of the tumor.

Setting

Performed in a hospital operating room.

Personnel

• Neurosurgeon
• Surgical assistant(s)
• Anesthesiologist
• Scrub nurse
• Circulating nurse
• Neuro-monitoring staff (optional)

Risks and Complications

• Bleeding or infection
• Cerebrospinal fluid leak
• Hearing loss or facial nerve damage
• Swelling or brain edema
• Blood clots
• Seizures
• Stroke or other neurological deficits

Benefits

• Removal of tumor
• Relief from symptoms such as hearing loss, vertigo, and balance issues
• Prevention of further neurological damage
• Potential improvement in quality of life

Recovery

• Initial recovery in the intensive care unit (ICU) for close monitoring
• Hospital stay of 1 to 2 weeks
• Post-surgical pain management and antibiotics
• Restricted activities (e.g., no heavy lifting) for several weeks
• Scheduled follow-up appointments for wound care and monitoring recovery
• Possible physical or speech therapy depending on the extent of neurological impact

Alternatives

• Stereotactic radiosurgery (e.g., Gamma Knife), for smaller tumors or patients unfit for surgery
• Observation with regular imaging, for slow-growing or asymptomatic tumors
• Traditional open craniotomy without a transtemporal approach

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, the patient may experience headaches, swelling, and some discomfort at the incision site. These can usually be managed with prescribed pain medications. It is normal to feel tired and require additional rest during the recovery period. Regular follow-up visits will ensure proper healing and manage any potential complications.