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In this operative video, I demonstrate a retrosigmoid approach for resection of a large acoustic neuroma. Fine bipolar forceps are used to separate the arachnoid bands from the tumor capsule, while sharp dissection helps define the plane between the lesion and the brainstem.After internal debulking with the ultrasonic aspirator, the tumor capsule becomes more mobile, allowing the dissection to proceed with greater control. Throughout this step, preserving the pial membrane is critical. It protec
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