Vestibular schwannoma: suboccipital approach.
Microsurgery via the suboccipital approach is a common treatment option for vestibular schwannomas (VS). The procedure is performed under general anesthesia with cranial nerve monitoring in the supine position. Following suboccipital craniectomy, durotomy, CSF release from the foramen magnum, and identification of cranial nerve position, the tumor is debulked internally. The internal auditory canal is drilled and dissection of the tumor progresses. Following resection, the IAC is waxed and a fat graft placed. A watertight pericranial graft is sewn in and a titanium mesh cranioplasty placed. The muscle and skin are closed in layers. The video can be found here: http://youtu.be/ialtKy3cuPU .