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A stepwise illustration of the translabyrinthine approach to a large cystic vestibular schwannoma.

ABSTRACT: Of the presigmoid approaches, the translabyrinthine approach is often used when a large exposure is needed to gain access to the cerebellopontine angle but when hearing preservation is not a concern. At the authors' institution, this approach is done with the aid of ENT/otolaryngology for temporal bone drilling and exposure. In the present article and video, the authors demonstrate the use of the translabyrinthine approach for resection of a large cystic vestibular schwannoma, delineating the steps of positioning, opening, temporal bone drilling, tumor resection, and closure. Gross-total resection was achieved in the featured case. The patient's postoperative facial function was House-Brackmann Grade II on the side ipsilateral to the tumor, although function improved with time. The translabyrinthine route to the cerebellopontine angle is an excellent approach for masses that extend toward the midline or anterior to the pons. Although hearing is sacrificed, facial nerve function is generally spared.

SUBMITTER: Nickele CM

PROVIDER: S-EPMC3675780 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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A stepwise illustration of the translabyrinthine approach to a large cystic vestibular schwannoma.

Nickele Christopher M CM Akture Erinc E Gubbels Samuel P SP Başkaya Mustafa K MK

Neurosurgical focus 20120901 3

Of the presigmoid approaches, the translabyrinthine approach is often used when a large exposure is needed to gain access to the cerebellopontine angle but when hearing preservation is not a concern. At the authors' institution, this approach is done with the aid of ENT/otolaryngology for temporal bone drilling and exposure. In the present article and video, the authors demonstrate the use of the translabyrinthine approach for resection of a large cystic vestibular schwannoma, delineating the ...[more]

PMID: 22937845

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Project description:BACKGROUND:Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope. METHODS:Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons' comfortability. RESULTS:A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n?=?39) or a surgical microscope (control, n?=?42). Patients in the two groups had comparable tumor location (P?=?0.439), Koos grading (P?=?0.867), and composition (P?=?0.891). While no significant differences in the duration of surgery (P?=?0.172), extent of tumor resection (P?=?0.858), facial function (P?=?0.838), and hearing ability (P?=?1.000), patients operated on under an exoscope had less blood loss (P?=?0.036) and a fewer field adjustments (P?<?0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P?=?0.001 and P?<?0.001, respectively). CONCLUSIONS:The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.

Dataset Information

A stepwise illustration of the translabyrinthine approach to a large cystic vestibular schwannoma.

Publications

A stepwise illustration of the translabyrinthine approach to a large cystic vestibular schwannoma.

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