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Wang Y, Piras G, Lauda L, Caruso A, Russo A, Taibah A, Sanna M. Superior petrosal vein sacrifice in translabyrinthine approach for resection of vestibule schwannoma. Eur Arch Otorhinolaryngol 2024; 281:1195-1203. [PMID: 37665344 DOI: 10.1007/s00405-023-08208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and surgical outcome of superior petrosal vein (SPV, Dandy's vein) sacrifice in translabyrinthine approach (TLA) for resection of vestibule schwannoma (VS) as compared with SPV preservation, with further investigation of preoperational factors associated with the implement of SPV sacrifice. METHODS The authors prospectively collected data from patients surgically treated for VS through TLA between June 2021 and April 2022 at the Gruppo Otologico. RESULTS There were 30 and 49 patients in SPV sacrifice and preservation groups, respectively. SPV sacrifice group had significantly larger tumor size (2.46 vs. 1.40 cm), less percentage of solid tumor (26.7% vs. 83.7%), higher incidence of brainstem compression (80% vs. 26.5%), and higher percentage of facial numbness (20.0% vs. 4.1%) than SPV preservation group. Gross total resection (GTR) rates were 73.3% after SPV sacrifice and 87.8% after SPV preservation. Facial nerve preservation rates were similar. No complication related with SPV sacrifice was observed. Logistic regression analysis showed tumor size and complete solid consistency as significant risk factors associated with SPV sacrifice. ROC curve further demonstrated tumor size as a fair predictor (AUC = 0.833), with optimum cutoff value of 1.68 cm. CONCLUSION SPV sacrifice via TLA as needed is a safe and effective maneuver for removal of relatively large VS. Tumor size and consistency can be used as a guidance in preoperational decision-making, with cutoff value of 1.68 cm and cystic formation as predictive indicators.
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Affiliation(s)
- Yongjie Wang
- Department of Neurosurgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Gianluca Piras
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy.
| | - Lorenzo Lauda
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Antonio Caruso
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Alessandra Russo
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Abdelkader Taibah
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Mario Sanna
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
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Schwam ZG, Cosetti MK, Wanna GB. Translabyrinthine Approach for Sporadic Vestibular Schwannoma: Patient Selection, Technical Pearls, and Patient Outcomes. Otolaryngol Clin North Am 2023; 56:483-493. [PMID: 36964096 DOI: 10.1016/j.otc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Herein we briefly describe the translabyrinthine approach to vestibular schwannoma resection as well as a focused literature review as to the best candidates, technical recommendations, and key outcomes with respect to other approaches.
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Affiliation(s)
- Zachary G Schwam
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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Suzuki Y, Noda K, Ota N, Kondo T, Haraguchi K, Miyoshi N, Kiko K, Yoshikawa K, Ono S, Mizuno H, Okada Y, Takano T, Yasuda S, Oda J, Kamiyama H, Tokuda S, Tanikawa R. A case of facial nerve palsy caused by severe head injury treated by translabyrinthine approach. Surg Neurol Int 2023; 14:47. [PMID: 36895239 PMCID: PMC9990793 DOI: 10.25259/sni_995_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
Background Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial. Case Description A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle. Conclusion Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.
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Affiliation(s)
- Yosuke Suzuki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Tomomasa Kondo
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kenichi Haraguchi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Norio Miyoshi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Katsunari Kiko
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kohei Yoshikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Shun Ono
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyuki Mizuno
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takuma Takano
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Soichiro Yasuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Jumpei Oda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Japan
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Revuelta Barbero JM, Porto E, Medina EJ, Bray DP, Garzon-Muvdi T, Solares CA, Pradilla G. Microsurgical Gross Total Resection of an Intracanalicular-Cisternal (Koos-4) Vestibular Schwannoma via a Retrosigmoid Approach with Intraoperative Endoscopic Assistance. World Neurosurg 2021; 158:225. [PMID: 34864191 DOI: 10.1016/j.wneu.2021.11.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
We present the case of a 23-year-old female with a history of progressive hearing loss in the left ear, dizziness, and vertigo. Magnetic resonance imaging demonstrated a left mass extending from the internal auditory canal into the cerebellopontine angle (Koos-4).1 A retrosigmoid approach assisted with a microinspection tool was chosen.2-5 Microsurgical near total resection was achieved. The patient presented a postoperative facial deficit (House-Brackman grade 2 postoperative), with complete resolution after 2 months. Video 1 highlights the critical steps of the retrosigmoid approach and the benefit of using the microinspection tool for vestibular schwannoma resection.
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Affiliation(s)
| | - Edoardo Porto
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Eduardo J Medina
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - David P Bray
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - C Arturo Solares
- Department of Otolaryngology Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
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Kiyofuji S, Neff BA, Carlson ML, Driscoll CLW, Link MJ. Large and small vestibular schwannomas: same, yet different tumors. Acta Neurochir (Wien) 2021; 163:2199-2207. [PMID: 33471207 DOI: 10.1007/s00701-021-04705-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vestibular schwannomas (VS) present at variable size with heterogeneous symptomatology. Modern treatment paradigms for large VS include gross total resection, subtotal resection (STR) in combination with observation, and/or radiation to achieve optimal function preservation, whereas treatment is felt to be both easier and safer for small VS. The objective is to better characterize the presentation and surgical outcomes of large and small VS. METHODS We collected data of patients who had surgically treated VS with a posterior fossa diameter of 4.0 cm or larger (large tumor group, LTG) and smaller than 1.0 cm in cisternal diameter (small tumor group, STG). Statistical significance was defined as p < 0.05. RESULTS LTG included 48 patients (average tumor size: 44.9 mm) and STG 38 (7.9 mm). Patients in STG presented more frequently with tinnitus and sudden hearing loss. Patients in LTG underwent more STR than STG (50.0% vs. 2.6%, p < 0.0001). LTG had more complications (31.3% vs. 13.2%, p = 0.049). Postoperative facial nerve function in STG was significantly better than LTG. STG had better hearing preoperatively (p < 0.0001) and postoperatively than LTG (p = 0.0002). Postoperative headache was more common in STG (13.2% vs. 2.1%, p = 0.045). The rate of recurrence/progression needing treatment was not statistically different between the groups (12.5% in LTG vs. 7.9% in STG, p = 0.49). Those patients who required periprocedural cerebrospinal fluid diversion had higher risk of infection (20.8% vs 4.8%, p = 0.022). CONCLUSION Large and small VS present differently. LTG showed more unsatisfactory outcomes in facial nerve function and postoperative hearing despite maximal efforts undertaken toward function-preservation strategy; however, similar tumor control was achieved.
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Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 154-0023, Japan.
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Brian A Neff
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Carlson
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Plainfossé O, Puechmaille M, Saroul N, Gilain L, Godey B, Pereira B, Khalil T, Mom T. Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells' partition. Eur Arch Otorhinolaryngol 2021. [PMID: 33942123 DOI: 10.1007/s00405-021-06850-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery. OBJECTIVE To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery. METHODS A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student's t or Chi-squared test in case of non-parametric distribution. RESULTS One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (11.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571). CONCLUSION Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%.
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Cooper MW, Ward BK, Sharon J, Francis HW. Reducing the risk of cerebrospinal fluid rhinorrhea following translabyrinthine surgery of the posterior fossa. World J Otorhinolaryngol Head Neck Surg 2021; 7:82-87. [PMID: 33997716 PMCID: PMC8103534 DOI: 10.1016/j.wjorl.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube. Methods Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique. Results In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery. Conclusion Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.
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Affiliation(s)
- Matthew W Cooper
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffery Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Howard W Francis
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
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Pogoda L, Nijdam JS, Smeeing DPJ, Voormolen EHJ, Ziylan F, Thomeer HGXM. Postoperative headache after surgical treatment of cerebellopontine angle tumors: a systematic review. Eur Arch Otorhinolaryngol 2021; 278:3643-51. [PMID: 33523284 DOI: 10.1007/s00405-021-06627-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/16/2021] [Indexed: 11/05/2022]
Abstract
Purpose Postoperative headache (POH) is a complication that occurs after surgical resection of cerebellopontine angle (CPA) tumors. The two most common surgical approaches are the translabyrinthine (TL), and retrosigmoid (RS) approach. The objective of this systematic review was to investigate whether POH occurs more frequently after RS compared to TL approaches. Methods A systematic search was conducted in Cochrane, Pubmed and Embase. Studies were included if POH after CPA tumor removal was reported and both surgical approaches were compared. The methodological quality of the studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Results In total, 3,942 unique articles were screened by title and abstract. After the initial screening process 63 articles were screened for relevance to the inquiry, of which seven studies were included. Three studies found no significant difference between both surgical approaches (p = 0.871, p = 0.120, p = 0.592). Three other studies found a lower rate of POH in the TL group compared to the RS group (p = 0.019, p < 0.001, p < 0.001). Another study showed a significantly lower POH rate in the TL group after one and six months (p = 0.006), but not after 1 year (p = 0.6). Conclusion The results of this systematic review show some evidence of a lower rate of POH in favor of the TL approach versus the RS approach for CPA tumor resection. Prospective research studies are needed to further investigate this finding.
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Roberti F, Wind JJ, Perez R, Caputy AJ. The translabyrinthine approach in residency training. "Step by step" surgical anatomy from the dissection laboratory to the operative room. J Otol 2020; 16:99-108. [PMID: 33777123 PMCID: PMC7985018 DOI: 10.1016/j.joto.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022] Open
Abstract
Surgical anatomy training in a dedicated research laboratory and attendance to focused “hands-on” dissection courses are of high educational importance in order to acquire and maintain surgical expertise in skull base surgery, both for young and more experienced surgeons. Nevertheless, transitioning surgical skills and anatomic knowledge from the laboratory to the operative room it is not free of challenges, especially during skull base approaches where the three-dimensional surgical orientation can be quite complex. We present a “step-by-step” and “side-by-side” surgical anatomy report on a translabyrinthine approach that was practiced in the laboratory then performed in the operative room by the surgical team, and we compare surgical anatomy exposures while discussing intraoperative techniques, nuances and challenges, both in the laboratory and the operative room.
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Affiliation(s)
- Fabio Roberti
- Dept. of Neurological Surgery, The George Washington University, Washington DC, USA
| | - Joshua J Wind
- Dept. of Neurological Surgery, The George Washington University, Washington DC, USA
| | - Rosa Perez
- Dept. of Neurological Surgery, The George Washington University, Washington DC, USA
| | - Anthony J Caputy
- Dept. of Neurological Surgery, The George Washington University, Washington DC, USA
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Gao Z, Tang WL, Qin ZJ, Zhao WD, Dai CF, Chi FL, Yuan YS. Modified Translabyrinthine Approach for Massive Petrous Bone Cholesteatoma Removal and Cochlear Preservation Using Latent Spaces Anterior to the Cochlea. World Neurosurg 2020; 143:84-90. [PMID: 32730964 DOI: 10.1016/j.wneu.2020.07.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Microsurgery is the reference standard treatment of petrous bone cholesteatoma (PBC). In most cases, radical removal of an extensive PBC can only be achieved at the cost of sacrificing the cochlea. Such treatment will result in the impossibility of future cochlear implantation for hearing rehabilitation purposes. To address this issue, a modification of the traditional translabyrinthine (TL) approach with endoscopic assistance has been developed for radical removal of extensive PBC with preservation of the cochlea. METHODS From June 2017 to December 2017, 3 patients with a massive PBC underwent surgical removal using the modified TL approach by the senior author in our department. We reviewed the patient characteristics and retrospectively studied the surgical outcomes and postoperative complications. In the present report, we have described our modified TL approach in detail. RESULTS Complete resection of the PBC and successful cochlea preservation were achieved in all 3 patients. No recurrence had developed during the follow-up period. However, various degrees of cochlear ossification were observed in 2 patients postoperatively. CONCLUSIONS This modified TL approach provides the possibility of fully exposing the whole petrous apex without removing the cochlea in selected cases. However, the development of long-term cochlear ossification requires further investigation to allow for successful cochlear implantation.
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Affiliation(s)
- Zhen Gao
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Wen-Long Tang
- Department of Neurosurgery, Peace Hospital of Changzhi Medical College, Changzhi, People's Republic of China
| | - Zhao-Jun Qin
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Wei-Dong Zhao
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Chun-Fu Dai
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Fang-Lu Chi
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China
| | - Ya-Sheng Yuan
- Department of Otology and Skull Base Surgery, Eye and ENT Hospital, Fudan University, Shanghai, People's Republic of China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, People's Republic of China.
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Goyal S, Natarajan K, Devarasetty A, Sarankumar T, Chauhan N, Kameswaran M. Translabyrinthine approach to internal auditory meatus: A retrospective study. Med J Armed Forces India 2018; 74:65-71. [PMID: 29386735 DOI: 10.1016/j.mjafi.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/11/2016] [Indexed: 12/12/2022] Open
Abstract
Background Ear and the lateral skull base surgery is challenging and yet fascinating for a Neuro-otologist. A thorough knowledge of the complex anatomy is indispensable for the surgeon in order to provide the best possible care. Methods The aim of the study was to highlight the present day indications for translabyrinthine approach to IAM from a Neuro-otologist perspective. Results There were a total of 7 patients who underwent Translabyrinthine approach at our centre. In the present study we have reported cases of Vestibular Schwannoma, Facial nerve schwannoma, Cholesteatoma involving the IAM, Meniere's disease with refractory vertigo which were managed via translabyrinthine approach. We also encountered, probably the first reported case, tuberculoma of the IAM which was clinical suspected to be vestibular schwannoma. Conclusion The article presents different clinical situations where this approach can be suitably utilized and has been dealt with via a retrospective study encountered at our centre.
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Affiliation(s)
- Sunil Goyal
- Neuro-otology Trainee, Madras ENT Research Foundation (Pvt) Ltd, Raja Annamalai Puram, Chennai 600028, India
| | - Kiran Natarajan
- Senior Consultant (ENT), Madras ENT Research Foundation (Pvt) Ltd, Raja Annamalai Puram, Chennai 600028, India
| | - Amarnath Devarasetty
- Junior Consultant (ENT), Madras ENT Research Foundation (Pvt) Ltd, Raja Annamalai Puram, Chennai 600028, India
| | - T Sarankumar
- Trained in Implant Otology, Junior Consultant (ENT), Madras ENT Research Foundation (Pvt) Ltd, Raja Annamalai Puram, Chennai 600028, India
| | - Neha Chauhan
- Fellow in Implant Otology, Madras ENT Research Foundation (Pvt) Ltd, Raja Annamalai Puram, Chennai 600028, India
| | - Mohan Kameswaran
- Head & Senior Consultant (ENT), Madras ENT Research Foundation (Pvt) Ltd, Raja Annamalai Puram, Chennai 600028, India
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Delgado-Vargas B, Medina M, Polo R, Lloris A, Vaca M, Pérez C, Cordero A, Cobeta I. Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation. ACTA ACUST UNITED AC 2017; 38:56-60. [PMID: 29187758 DOI: 10.14639/0392-100x-1218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/06/2017] [Indexed: 11/23/2022]
Abstract
The most frequent sequelae following a translabyrinthine approach for vestibular schwannoma resection is complete hearing loss on the affected side. Such patients could benefit from a cochlear implant, provided that two essential requisites are met before surgery: a preserved cochlear nerve and a patent cochlea to accommodate the electrode array. The goal of our study is to determine the prevalence and extent of cochlear ossification following a translabyrinthine approach. Postoperative MRI of 41 patients were retrospectively reviewed. Patients were classified according to the degree of cochlear obliteration into three groups (patent cochlea, partially obliterated cochlea and totally obliterated cochlea). The interval between surgery and the first MRI was studied as well as its relationship with the rate of cochlear ossification. At first postoperative MRI (mean interval of 20 months), 78% of patients showed some degree of cochlear ossification. Differences were found in the time interval between surgery and first MRI for each group, showing a smaller interval of time the patent cochlea group (p > 0.05). When MRI was performed before the first year after surgery, a larger rate of patent cochlea was found (p > 0.05). The present study suggests that cochlear ossification is a time-depending process, whose grounds are still to be defined.
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Affiliation(s)
- B Delgado-Vargas
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
| | - M Medina
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
| | - R Polo
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
| | - A Lloris
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
| | - M Vaca
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
| | - C Pérez
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
| | - A Cordero
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
| | - I Cobeta
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo, Madrid, Spain
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13
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Abstract
BACKGROUND Microsurgical resection of vestibular schwannomas is demanding, even if not all of these tumors represent a challenge for experienced surgeons. In order to make the right decisions when it comes to balancing the extent of tumor resection with preservation of function, the surgeon must possess detailed knowledge of the surgical techniques and also have mastered these. OBJECTIVE The current article describes the state-of-the-art of the three major microsurgical techniques for resection of vestibular schwannomas, their pearls and their perils. MATERIALS AND METHODS The literature-based review of the three surgical techniques is complemented by a discussion of operative nuances and weighting of advantages and possible complications based on the authors' own experience. RESULTS The translabyrinthine, retrosigmoidal, and subtemporal microsurgical approaches are well documented in the literature regarding their modifications and the achievable surgical results. Hearing preservation is possible with the latter two approaches. The choice of approach and the preservation of neural function depend primarily on the size of the tumor and pre-existing neurologic deficits. Preoperative diagnostics and preparation differ only for semi-sitting patient positioning, where transesophageal echocardiography is required. The classic surgical techniques have been supplemented by fine-tuned electrophysiologic monitoring, endoscopic views, special microinstruments, and intraoperative image guidance. CONCLUSION The choice of surgical approach often depends on the personal preference and experience of the surgeon. Preoperative hearing and tumor extension are the main objective selection criteria.
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Affiliation(s)
- S Rosahl
- Klinik für Neurochirurgie, HELIOS Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Deutschland.
| | - D Eßer
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Plastische Operationen, HELIOS Klinikum Erfurt, Erfurt, Deutschland
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14
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Mazzoni A, Zanoletti E, Faccioli C, Martini A. Acoustic schwannoma with intracochlear extension and primary intracochlear schwannoma: removal through translabyrinthine approach with facial bridge cochleostomy and transcanal approach. Eur Arch Otorhinolaryngol 2017; 274:2149-54. [PMID: 28243783 DOI: 10.1007/s00405-017-4501-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
Intracochlear schwannomas can occur either as an extension of a larger tumor from the internal auditory canal, or as a solitary labyrinthine tumor. They are currently removed via a translabyrinthine approach extended to the basal turn, adding a transotic approach for tumors lying beyond the basal turn. Facial bridge cochleostomy may be associated with the translabyrinthine approach to enable the whole cochlea to be approached without sacrificing the external auditory canal and tympanum. We describe seven cases, five of which underwent cochlear schwannoma resection with facial bridge cochleostomy, one case with the same procedure for a suspect tumor and one, previously subjected to radical tympanomastoidectomy, who underwent schwannoma resection via a transotic approach. Facial bridge cochleostomy involved removing the bone between the labyrinthine and tympanic portions of the fallopian canal, and exposing the cochlea from the basal to the apical turn. Patients' recovery was uneventful, and long-term magnetic resonance imaging showed no residual tumor. Facial bridge cochleostomy can be a flexible extension of the translabyrinthine approach for tumors extending from the internal auditory canal to the cochlea. The transcanal approach is suitable for the primary exclusive intralabyrinthine tumor. The indications for the different approaches are discussed.
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15
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Zanoletti E, Faccioli C, Martini A. Surgical treatment of acoustic neuroma: Outcomes and indications. Rep Pract Oncol Radiother 2015; 21:395-8. [PMID: 27330426 DOI: 10.1016/j.rpor.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022] Open
Abstract
AIM Surgery for acoustic neuroma has developed over the years with a gradual improvement in outcome. The goal of surgery should be cure of the disease and a low morbidity, preserving facial nerve function - and hearing, too, whenever feasible (i.e. in small tumors). The most appropriate approach must be decided case by case. BACKGROUND Results of microsurgery remain heterogeneous, however, probably due to the different amount of experience gained at different centers. MATERIALS AND METHODS Surgical series reported in the recent literature (2012-2015) were critically reviewed, along with some older papers with particularly representative series. RESULTS AND CONCLUSION Considering patients' age, surgical morbidity of different approaches, tumor size and hearing, some principles can be identified on which to base surgical indications with a view to achieving the goals of curing the disease with a low morbidity, preserving facial nerve function and hearing, too, whenever feasible (i.e. in patients with small tumors). Different therapeutic approaches are discussed.
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Affiliation(s)
- Elisabetta Zanoletti
- Otolaryngology, Neurosciences Department, University Hospital, Padua, via N. Giustiniani 2, 35128 Padova, Italy
| | - Chiara Faccioli
- Otolaryngology, Neurosciences Department, University Hospital, Padua, via N. Giustiniani 2, 35128 Padova, Italy
| | - Alessandro Martini
- Otolaryngology, Neurosciences Department, University Hospital, Padua, via N. Giustiniani 2, 35128 Padova, Italy
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16
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Bambakidis NC, Munyon C, Ko A, Selman WR, Megerian CA. A novel method of translabyrinthine cranioplasty using hydroxyapatite cement and titanium mesh: a technical report. Skull Base 2011; 20:157-61. [PMID: 21318032 DOI: 10.1055/s-0029-1246222] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report a novel technique for closure using titanium mesh cranioplasty in addition to hydroxyapatite cement and abdominal fat graft for acoustic neuroma. We reviewed 15 patients who underwent translabyrinthine craniectomy for resection of acoustic neuroma. Hearing loss was documented prior to surgical procedure. Over 2 years, patients underwent titanium mesh and hydroxyapatite cranioplasty with abdominal fat graft. Participants included seven men and eight women, age range 38 to 65. Main outcome measures included cosmetic outcome and incidence of cerebrospinal fluid (CSF) leak. The lesion was right-sided in seven patients and left-sided in eight. Cosmetic outcome was excellent in all. There were no cases of CSF leak. Closure used one-third the hydroxyapatite required for traditional closure. Our technique yields cosmetic results equivalent to hydroxyapatite cement alone and a comparable incidence of CSF leakage without leaving a drain in place postoperatively. The technique is easy to adopt, is more cost-effective than hydroxyapatite cement cranioplasty alone, offers greater ease of access for reoperation, and does not preclude later implantation of bone-anchored hearing aid.
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Affiliation(s)
- Nicholas C Bambakidis
- Department of Neurological Surgery, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland, Ohio
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Jayashankar N, Morwani KP, Sankhla SK, Agrawal R. The enlarged translabyrinthine and transapical extension type I approach for large vestibular schwannomas. Indian J Otolaryngol Head Neck Surg 2011; 62:360-4. [PMID: 22319693 DOI: 10.1007/s12070-010-0057-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 10/10/2010] [Indexed: 10/18/2022] Open
Abstract
To evaluate the results obtained by performing the enlarged translabyrinthine and transapical extension type I approaches for removal of large vestibular schwannomas and those with anterior extensions. An academic tertiary referral centre at Mumbai, India. Retrospective case review. 35 patients of vestibular schwannomas having size greater than 3 cm in extrameatal diameter with extension anterior to the internal auditory canal who underwent the enlarged translabyrinthine or transapical extension type I approach and with a minimum follow up of 1 year are considered. Other subjects who underwent translabyrinthine approach but did not fulfill the above criteria were excluded. Tumor was removed completely in 34 subjects (97.1%). Anatomic interruption of facial nerve occured in 4 cases (11.4%); 3 subjects underwent end to end anastomosis and 1 subject required a cable graft, these were done during the primary procedure itself. At 1 year follow up 28 subjects (80%) had good facial function (Grade I and II, House Brackmann Grading). Postoperative cerebrospinal fluid leak was encountered in 1 subject (2.9%). 34 subjects (97.1%) had a normal albeit slow gait by the sixth post-operative day. Complete tumor removal with a very low morbidity in our series suggest that the enlarged translabyrinthine and transapical extension type I approach offers excellent control of the neurovascular structures in the cerebellopontine angle as also of the large vestibular schwannoma itself aiding complete removal. It also offers the advantage of management of the interrupted facial nerve at the primary procedure itself since the proximal and distal segments are in the operative field.
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