ABSTRACT
The present study included 66 patients with cerebello-pontine angle [CPA] tumours. Retro sigmoid approach was done in 53 patients with CPA tumours, 29 retrospective cases and 24 pospective. Trans labyrinthine approach was done in 13 patients with CPA tumours, 8 retrospective cases and 5 prospective. Out of the 66 patients with CPA tumours ,40 cases were vestibular schwannomas, 14 were meningioma's, two arachnoid cysts, two epidermoid and eight patients with other tumours. In sub occipital retrosigmoid cases total resection were done in 71.42% and subtotal in 28.58%. Mortality occurred in 3 cases, facial nerve affection in 21.46%, hearing loss in 21.46% and CSF leakage in 7.14%. In trans labyrinthine cases total radicality occurred in 76.9% and subtotal in 25.1%. No mortality was recorded, hearing loss in all, CSF leakage in 7. 7%. Follow-up of patients for one year showed good preservation of facial nerve function in 76.9%·with trans labyrinthine resection as measured by House and Brackmann system. Facial nerve preservation occurred in all cases with small tumours, 50% of medium sized and55.5% of large tumours. With retro sigmoid resection of schwannomas facial nerve preservation was found in 85.71%.Complete hearing loss occurred in all patients with trans labyrinthine approach. Follow up of retro sigmoid surgery showed hearing preservation with good serviceable haring in 75% of moderate sized acoustic neuromas and hearing loss occurred in 21.46% in whole group of schwannoma. The present study demonstrated that with unserviceable hearing, the trans labyrinthine approach, whatever the size ·of the tumour, is the approach of choice. Young patients with good preoperative hearing are candidates for retro sigmoid surgery. If there is doubt concerning residual tumour the labyrinth should be sacrificed. With patients with tumours smaller than 1.5cm in diameter and in patients with good hearing and no extension in internal auditory canal, retro sigmoid approach is used. Tumours -size larger than 1.5 cm can be accessed by retro sigmoid or trans labyrinthine approaches