Surgical treatment process for a 4 cm acoustic neuroma

A 4 cm acoustic neuroma is considered a relatively large tumor, and surgical resection is generally required. The procedure should be performed at a正规 hospital, with the following specific steps:

1. The patient is placed in a lateral position. The anesthesiologist administers general anesthesia, while the surgeon routinely disinfects the scalp, skin around the ear, cheek, and the occipital region of the neck.

2. After anesthesia takes effect, the surgeon makes a curved incision within the hairline behind the ear, starting above the attachment line of the auricle, extending backward 4–5 cm, then turning downward to end approximately 2 cm behind the mastoid tip and 1–2 cm below the level of the mastoid tip.

3. A hole is drilled into the skull bone. After penetrating the cranial bone, a rongeur is used to gradually remove the occipital bone, exposing the dura mater. The dura is opened to reveal the cerebellopontine cistern, where a 4 cm acoustic neuroma can be seen.

4. A dissector is used to separate the arachnoid membrane surrounding the tumor. Blood vessels connected to the tumor are coagulated and severed using bipolar electrocautery. The interface between the tumor and surrounding nerves is carefully identified, and the tumor is peeled away from the nerve. The intrameatal portion of the tumor within the internal auditory canal is then exposed and removed.

5. After tumor removal, a dural patch and gelatin sponge are packed into the wound site. The dura mater is sutured closed, the bone flap is repositioned, and the muscle and scalp are sutured in layers. The surgery concludes at this stage.

After surgery, patients should follow medical staff instructions and avoid making independent decisions. If facial paralysis occurs postoperatively, timely measures for corneal protection should be implemented.