Transcanal surgery for vestibular schwannomas: a pictorial review of radiological findings, surgical anatomy and comparison to the traditional translabyrinthine approach

Alicandri‐Ciufelli, Matteo; Federici, Gaia; Anschuetz, Lukas; Pavesi, Giacomo; Todeschini, Alice; Presutti, Livio; Marchioni, Daniele

doi:10.1007/s00405-017-4630-8

Cited by 15 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on our first experience, TTVN is a feasible and minimally invasive surgical technique. With TTVN, it is possible to perform a neurectomy, avoiding some of the limitations of traditional approaches such as craniotomy, and brain, middle, and posterior fossa manipulations (13,18).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transcanal Transvestibular Endoscopic Neurectomy: First Experience

Marchioni

Caiazza

Calabrese

et al. 2021

Otology &Amp; Neurotology

Self Cite

View full text Add to dashboard Cite

Objective: Me ´nie `re's disease is an idiopathic inner ear disorder characterized by recurrent vertigo, fluctuating sensorineural hearing loss, and persistent tinnitus. In 10% to 30% of cases, conservative therapy fails, and Me ´nie `re's disease is defined as intractable. In these patients, ablative techniques with unilateral vestibular deafferentation are mandatory. Several approaches for vestibular neurectomy, which preserve hearing capability, are described. In patients presenting severe dizziness associated with high-grade sensorineural hearing loss, surgical labyrinthectomy, or selected vestibular neurectomy through a translabyrinthine approach are the treatments commonly considered. This study reports the first application of transcanal transvestibular endoscopic neurectomy in two patients with frequent disabling vertigo and high-grade sensorineural hypoacusia. Methods: This was a retrospective chart review including patients with intractable Me ´nie `re's disease who underwent vestibular neurectomy, performed in our ENT department between January 2017 and January 2020, selecting patients with disabling vertigo and high-grade sensorineural hypoacusia. We describe step-by-step the surgical technique of transcanal transvestibular endoscopic neurectomy. Results: Overall, two patients underwent transcanal transvestibular endoscopic neurectomy. We performed transcanal transvestibular neurectomy in all cases. No intraoperative complications were observed. On the 2nd postoperative day, one patient presented CSF leak, leading to surgical revision. A complete resolution of vertigo attacks was observed 6 months after surgery. Conclusion: Even though this study presents a limited number of cases, transcanal transvestibular neurectomy is a promising, safe, and effective procedure in selected cases.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Recently, transcanal transpromontorial approaches have been developed to access the inner ear directly through the external auditory canal (EAC) (13). These approaches are an exclusive endoscopic technique providing a direct corridor to the IAC.…”

Section: Introductionmentioning

confidence: 99%

Transcanal Transvestibular Endoscopic Neurectomy: First Experience

Marchioni

Caiazza

Calabrese

et al. 2021

Otology &Amp; Neurotology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Treatment is indicated for progressive tumor growth, progressive hearing loss, control of vertigo, or extension of the tumor into the internal auditory canal. Besides radiation therapy, different surgical techniques are described ranging from transotic tumor resection with middle ear obliteration and blind sac closure of the external auditory canal to transmastoid labyrinthectomy, to microscopic or endoscopic transcanal tumor resection with or without simultaneous CI, to partial/subtotal cochleoectomy with simultaneous CI, or to CI without tumor removal (as in patient 3) [Carlson et al, 2015;Alicandri-Ciufelli et al, 2017;Mazzoni et al, 2017;Xia et al, 2017;Plontke et al, 2018;Ma and Patel, 2020]. The simultaneous resection of the ILS and placement of a CI shows promising results with regard to hearing rehabilitation despite opening of the cochlea [Plontke et al, 2020a].…”

Section: Discussionmentioning

confidence: 99%

Histopathologic Evaluation of Intralabyrinthine Schwannoma

2020

View full text Add to dashboard Cite

Objectives: The aim of this study is to perform a histopathologic analysis of temporal bones with an intralabyrinthine schwannoma (ILS) in order to characterize its extension. Methods: Archival temporal bones with a diagnosis of sporadic schwannoma were identified. Both symptomatic and occult nonoperated ILS were included for further analysis. Results: A total of 6 ILS were identified, with 4 intracochlear and 2 intravestibular schwannomas. All intracochlear schwannomas involved the osseous spiral lamina, with 2 extending into the modiolus. The intravestibular schwannomas were limited to the vestibule, but growth into the bone next to the crista of the lateral semicircular canal was observed in 1 patient. Conclusions: Complete removal of an ILS may require partial removal of the modiolus or bone surrounding the crista ampullaris as an ILS may extend into these structures, risking damage of the neuronal structures. Due to the slow growth of the ILS, it remains unclear if a complete resection is required with the risk of destroying neural structures hindering hearing rehabilitation with a cochlear implant.

show abstract

“…In parallel with the evolution of our own practice, other authors have increasingly demonstrated a role for the endoscope in CPA surgery, either as an adjunct to the microscope, or the primary visualization modality, a trend that may further enhance the utility and dynamism of the retrosigmoid approach across a broad range of clinical contexts. [30][31][32][33] Ultimately, we emphasize the importance of a broad, inclusive, and anatomically oriented skull base education which we anticipate will be well-informed by these dissections and guides that can empower individuals at all stages of training to learn and reproduce the core approach techniques.…”

Section: Clinical Pearls For Selection Of a Retrosigmoid Approachmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Retrosigmoid Approach

Graffeo

Peris-Celda

Perry

et al. 2019

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Introduction Neurosurgical anatomy is traditionally taught via anatomic and operative atlases; however, these resources present the skull base using views that emphasize three-dimensional (3D) relationships rather than operative perspectives, and are frequently written above a typical resident's understanding. Our objective is to describe, step-by-step, a retrosigmoid approach dissection, in a way that is educationally valuable for trainees at numerous levels. Methods Six sides of three formalin-fixed latex-injected specimens were dissected under microscopic magnification. A retrosigmoid was performed by each of three neurosurgery residents, under supervision by the senior authors (C.L.W.D. and M.J.L.) and a graduated skull base fellow, neurosurgeon, and neuroanatomist (M.P.C.). Dissections were supplemented with representative case applications. Results The retrosigmoid craniotomy (aka lateral suboccipital approach) affords excellent access to cranial nerve (CN) IV to XII, with corresponding applicability to numerous posterior fossa operations. Key steps include positioning and skin incision, scalp and muscle flaps, burr hole and parasigmoid trough, craniotomy flap elevation, initial durotomy and deep cistern access, completion durotomy, and final exposure. Conclusion The retrosigmoid craniotomy is a workhorse skull base exposure, particularly for lesions located predominantly in the cerebellopontine angle. Operatively oriented neuroanatomy dissections provide trainees with a critical foundation for learning this fundamental skull base technique. We outline a comprehensive approach for neurosurgery residents to develop their familiarity with the retrosigmoid craniotomy in the cadaver laboratory in a way that simultaneously informs rapid learning in the operating room, and an understanding of its potential for wide clinical application to skull base diseases.

show abstract

Transcanal surgery for vestibular schwannomas: a pictorial review of radiological findings, surgical anatomy and comparison to the traditional translabyrinthine approach

Abstract: 4.

Cited by 15 publications

References 11 publications

Transcanal Transvestibular Endoscopic Neurectomy: First Experience

Transcanal Transvestibular Endoscopic Neurectomy: First Experience

Histopathologic Evaluation of Intralabyrinthine Schwannoma

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Retrosigmoid Approach

Contact Info

Product

Resources

About