Acoustic neuroma recurrence after suboccipital resection: management with translabyrinthine resection.

Thirty-five patients with recurrent acoustic tumors have been studied before, during, and after revision surgery. Each had their original surgery via a suboccipital approach. Six patients had undergone multiple suboccipital surgeries. Revision surgery was accomplished using a translabyrinthine approach in all patients. Total tumor removal was possible in 33 patients. No second recurrences have occurred to date among the patients with total tumor removal. Anatomic facial nerve integrity was maintained in 24 patients. All recurrent tumors were present in the lateral internal auditory canal. Direct tumor access in this area is not possible with the suboccipital approach without entering the vestibular labyrinth. The suboccipital approach to acoustic neuromas is contraindicated if tumor extends to the fundus of the internal auditory canal. Translabyrinthine resection is the treatment of choice for recurrence of acoustic neuroma after primary suboccipital resection.