{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T23:01:28Z","timestamp":1768777288237,"version":"3.49.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T00:00:00Z","timestamp":1656979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Exposure of the posterior skull base and the cerebellopontine angle is challenging due to important neurovascular structures. The retrosigmoid approach (RSA) has become the standard method used in surgery. We report our experiences with RSAs regarding technical obstacles, complications, and approach-related outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We performed a retrospective chart review at a tertiary neurosurgical center between January 2007 and September 2020. We included all patients undergoing surgery for oncologic lesions through RSAs, concentrating on surgical technique, postoperative outcome, and complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 449 RSAs were included. The median age at the time of surgery was 58 years; 168 (37.4%) were male and 281 (62.6%) were female. The median approach surface was 7.8 cm<jats:sup>2<\/jats:sup>. The median tumor volume was 5.9 cm<jats:sup>3<\/jats:sup>. The median Clavien\u2013Dindo grade was 2, the total complication rate was 28.7%, and gross total resection (GTR) was 78.8%. Findings revealed that tumor volume had no significant impact on postoperative complications in general (p = 0.086) but had a significant impact on postoperative hemorrhage (p = 0.037) and hydrocephalus (p = 0.019). Tumor volume was significant for several preoperative symptoms (p &amp;lt; 0.001). The extent of the approach had no significant impact on complications in general (p = 0.120) but was significant regarding postoperative cerebrospinal fluid (CSF) leaks (p = 0.008). Craniotomy size was not significant regarding GTR (p = 0.178); GTR rate just missed significant correlation with tumor volume (p = 0.056). However, in the case of vestibular schwannomas, the size of craniotomy was important for GTR (p = 0.041).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Tumor volume has an important impact on preoperative symptoms as well as on postoperative complications. Although the extent of the craniotomy barely missed significance regarding GTR, a correlation can be assumed. Thus, the extent of craniotomy should be taken into presurgical consideration, especially in the case of postoperative CSF leaks. Regarding vestibular schwannomas, craniotomy size plays an important role in achieving satisfactory oncological outcomes. Different approaches should be selected where necessary regarding superior resection rates.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.938703","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T13:58:01Z","timestamp":1663941481000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases"],"prefix":"10.3389","volume":"12","author":[{"given":"Amir Kaywan","family":"Aftahy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Kathrin","family":"J\u00f6rger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Hillebrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix N.","family":"Harder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Wiestler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Bernhardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Negwer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Gempt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"ons53","DOI":"10.1227\/NEU.0b013e3182889e59","article-title":"Retrosigmoid Intradural Inframeatal Approach: Indications and Technique","volume":"73","author":"Samii","year":"2013","journal-title":"Operative Neurosurg"},{"key":"B2","volume-title":"Surgery of the Skull Base: An Interdisciplinary Approach","author":"Samii","year":"2012"},{"key":"B3","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-540-49250-4_15","article-title":"Retrosigmoid Approach to the Posterior and Middle Fossae","volume-title":"Samii's Essentials in Neurosurgery","author":"Tatagiba","year":"2008"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2006.105.4.527","article-title":"Improved Preservation of Hearing and Facial Nerve Function in Vestibular Schwannoma Surgery via the Retrosigmoid Approach in a Series of 200 Patients","volume":"105","author":"Samii","year":"2006","journal-title":"J Neurosurg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200009001-00023","article-title":"The Temporal Bone and Transtemporal Approaches","volume":"47","author":"Rhoton","year":"2000","journal-title":"Neurosurgery"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1159\/000315900","article-title":"Petrous Bone Cholesteatoma: Classification, Management and Review of the Literature","volume":"16","author":"Sanna","year":"2011","journal-title":"Audiol Neurootol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000303218.61230.39","article-title":"Evolution of Surgical Approaches in the Treatment of Petroclival Meningiomas: A Retrospective Review","volume":"61","author":"Bambakidis","year":"2007","journal-title":"Neurosurgery"},{"key":"B8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/00006123-199701000-00002","article-title":"Management of 1000 Vestibular Schwannomas (Acoustic Neuromas): Surgical Management and Results With an Emphasis on Complications and How to Avoid Them","volume":"40","author":"Samii","year":"1997","journal-title":"Neurosurgery"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1995.82.5.0711","article-title":"Surgical Treatment of Trigeminal Schwannomas","volume":"82","author":"Samii","year":"1995","journal-title":"J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1995.82.6.0924","article-title":"Surgical Treatment of Jugular Foramen Schwannomas","volume":"82","author":"Samii","year":"1995","journal-title":"J Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1227\/NEU.0b013e31823583a1","article-title":"The Middle Fossa Approach and Extended Middle Fossa Approach: Technique and Operative Nuances","volume":"70","author":"Diaz Day","year":"2012","journal-title":"Neurosurgery"},{"key":"B12","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/FOC.2008.25.12.E6","article-title":"Surgical Management of Trigeminal Schwannomas","volume":"25","author":"Ramina","year":"2008","journal-title":"Neurosurg Focus"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1080\/0268869021000030249","article-title":"The Operative Learning Curve for Vestibular Schwannoma Excision via the Retrosigmoid Approach","volume":"16","author":"Elsmore","year":"2002","journal-title":"Br J Neurosurg"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1715811","article-title":"Acute Sigmoid Sinus Compromise Following Skull Base Procedures: Is a \"Laissez-Faire\" Approach Best","volume":"82","author":"Arnone","year":"2021","journal-title":"J Neurol Surg B Skull Base"},{"key":"B15","doi-asserted-by":"publisher","first-page":"ix","DOI":"10.1016\/j.otc.2012.02.001","article-title":"Retrosigmoid Approach: Indications, Techniques, and Results","volume":"45","author":"Elhammady","year":"2012","journal-title":"Otolaryngol Clin North Am"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/00129492-200203000-00006","article-title":"Retrosigmoid Approach for Small and Medium-Sized Acoustic Neuromas","volume":"23","author":"Magnan","year":"2002","journal-title":"Otol Neurotol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12883-017-0805-6","article-title":"Functional Outcome and Complications After the Microsurgical Removal of Giant Vestibular Schwannomas via the Retrosigmoid Approach: A Retrospective Review of 16-Year Experience in a Single Hospital","volume":"17","author":"Huang","year":"2017","journal-title":"BMC Neurol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s10143-013-0485-7","article-title":"Functional Outcome and Postoperative Complications After the Microsurgical Removal of Large Vestibular Schwannomas via the Retrosigmoid Approach: A Meta-Analysis","volume":"37","author":"Zou","year":"2014","journal-title":"Neurosurg Rev"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.4103\/ajns.AJNS_192_18","article-title":"The Retrosigmoid Approach: Workhorse for Petroclival Meningioma Surgery","volume":"14","author":"Singh","year":"2019","journal-title":"Asian J Neurosurg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2007.106.1.30","article-title":"Patterns of Skull Base Meningioma Progression After Failed Radiosurgery","volume":"106","author":"Couldwell","year":"2007","journal-title":"J Neurosurg JNS"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000255492.34063.32","article-title":"Risk of Malignancy After Gamma Knife Stereotactic Radiosurgery","volume":"60","author":"Rowe","year":"2007","journal-title":"Neurosurgery"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-198803000-00010","article-title":"Petrosal Approach for Petroclival Meningiomas","volume":"22","author":"Al-Mefty","year":"1988","journal-title":"Neurosurgery"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/BF01406489","article-title":"Middle Fossa Transpetrosal-Transtentorial Approaches for Petroclival Meningiomas Selective Pyramid Resection and Radicality","volume":"129","author":"Kawase","year":"1994","journal-title":"Acta Neurochirurgica"},{"key":"B24","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.3171\/2012.6.FOCUS12131","article-title":"Petrosal Approaches to Posterior Circulation Aneurysms","volume":"33","author":"Gross","year":"2012","journal-title":"Neurosurg Focus FOC"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2001.94.4.0660","article-title":"Transcrusal Approach to the Petroclival Region With Hearing Preservation. Technical Note and Illustrative Cases","volume":"94","author":"Horgan","year":"2001","journal-title":"J Neurosurg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.3171\/foc.2005.19.2.8","article-title":"Surgical Management of Petroclival Meningiomas: Factors Determining the Choice of Approach","volume":"19","author":"Erkmen","year":"2005","journal-title":"Neurosurg Focus"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199903000-00060","article-title":"Partial Labyrinthectomy Petrous Apicectomy Approach to Neoplastic and Vascular Lesions of the Petroclival Area","volume":"44","author":"Sekhar","year":"1999","journal-title":"Neurosurgery"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000255472.52882.D6","article-title":"Petroclival Meningiomas: Multimodality Treatment and Outcomes at Long-Term Follow-Up","volume":"60","author":"Natarajan","year":"2007","journal-title":"Neurosurgery"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2003.12.008","article-title":"Conventional Posterior Fossa Approach for Surgery on Petroclival Meningiomas: A Report on an Experience With 28 Cases","volume":"62","author":"Goel","year":"2004","journal-title":"Surg Neurol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-198901000-00003","article-title":"Surgery of Petroclival Meningiomas: Report of 24 Cases","volume":"24","author":"Samii","year":"1989","journal-title":"Neurosurgery"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199211000-00001","article-title":"Microsurgical Removal of Petroclival Meningiomas: A Report of 33 Patients","volume":"31","author":"Bricolo","year":"1992","journal-title":"Neurosurgery"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2006.104.1.137","article-title":"Quantitative Analysis of the Working Area and Angle of Attack for the Retrosigmoid, Combined Petrosal, and Transcochlear Approaches to the Petroclival Region","volume":"104","author":"Siwanuwatn","year":"2006","journal-title":"J Neurosurg"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3171\/2009.7.JNS0989","article-title":"Functional Outcome After Complete Surgical Removal of Giant Vestibular Schwannomas","volume":"112","author":"Samii","year":"2010","journal-title":"J Neurosurg"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200003000-00007","article-title":"Cystic Schwannomas of the Jugular Foramen: Clinical and Surgical Remarks","volume":"46","author":"Carvalho","year":"2000","journal-title":"Neurosurgery"},{"key":"B35","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1080\/02688697.2020.1754334","article-title":"Trigeminal Schwannoma: A Single-Center Experience With 43 Cases and Review of Literature","volume":"35","author":"Li","year":"2021","journal-title":"Br J Neurosurg"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.129.4.429","article-title":"Comparison of Facial Nerve Function Results After Translabyrinthine and Retrosigmoid Approach in Medium-Sized Tumors","volume":"129","author":"Mamikoglu","year":"2003","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1097\/00129492-200203000-00020","article-title":"Translabyrinthine Approach for the Management of Large and Giant Vestibular Schwannomas","volume":"23","author":"Mamikoglu","year":"2002","journal-title":"Otol Neurotol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.clineuro.2008.07.012","article-title":"Vestibular Schwannoma Microsurgery With Special Reference to Facial Nerve Preservation","volume":"111","author":"Chen","year":"2009","journal-title":"Clin Neurol Neurosurg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.938703\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T13:58:06Z","timestamp":1663941486000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.938703\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,5]]},"references-count":38,"alternative-id":["10.3389\/fonc.2022.938703"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.938703","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,5]]},"article-number":"938703"}}