Flexible endoscopic assistance in the surgical management of vestibular schwannomas

Corrivetti, Francesco; Cacciotti, Guglielmo; Scavo, Carlo Giacobbo; Roperto, Raffaelino; Stati, Giovanni; Sufianov, Albert; Mastronardi, Luciano

doi:10.1007/s10143-019-01195-0

Cited by 17 publications

(17 citation statements)

References 33 publications

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“…A pneumatic endoscope holder is surely more versatile but less flexible than freehand manipulation. In addition, navigating solely by endoscope is prone to disorientation and concomitant injuries to the vital and complex neurovasculature of CPA ( 37 ). Therefore, microscopic resection is still the mainstay of treating vestibular schwannomas.…”

Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Gao

et al. 2022

Front. Oncol.

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ObjectiveTo explore the role of neuroendoscope assistance during surgical resection of the intracanalicular portion of vestibular schwannomas via the retrosigmoid approach and the subsequent early facial nerve outcomes.MethodsPatients of vestibular schwannoma with intracanalicular extensions undergoing retrosigmoid dissection at a single institution were retrospectively analyzed in this study. Several surgical techniques were applied to ensure maximal and safe removal of tumors. Tumors extending less than 10 mm into the internal acoustic canal (IAC) were classified as Grade A, while those extending over 10 mm into IAC were taken as Grade B. Neuroendoscope was applied at the end of microscopic phase to search for potential remnants for Grade B tumors. Absolute tumor extension was defined and measured. House and Brackmann (HB) scale was used to evaluate immediate CN VII outcomes.ResultsOf the 61 patients, there were 38 females and 23 males. A total of 18 (29.51%) cases were Koos Grade II, 12 (19.67%) cases Koos Grade III, and 31 (50.82%) cases Koos Grade IV. There were 38 cases (62.30%) of Grade A and 23 cases (37.70%) of Grade B. Gross total resection was achieved in 60 cases (98.36%). Four cases of intracanalicular remnants were detected and completely removed under endoscopic visualizations. There was a significantly higher proportion (17%, p = 0.02) of intracanalicular remnants in Grade B than Grade A. CN VII and VIII were anatomically preserved in all cases. A total of 55 cases (90.16%) retained good (HB Grades 1 and 2) facial nerve outcomes.ConclusionsIn Grade B vestibular schwannomas, after maximal microsurgical removal, endoscopic evaluation of the intracanalicular portion revealed residual tumors in 17% of the patients. Hence endoscopic evaluation of the potential intracanalicular remnants for tumor extending over 10 mm within IAC (Grade B) is recommended.

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Section: Discussionmentioning

confidence: 99%

Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Gao

et al. 2022

Front. Oncol.

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“…Therefore, they were able to accomplish GTR in the majority of cases and near total resection in those cases in which a thin layer of tumor capsule was left around the facial nerve because of firm adherences of the tumor capsule. [ 11 ] Hearing preservation also implies anatomical respect of the inner ear structures when exposing the fundus of the IAC. The most lateral part of the IAC is not sufficiently visualized under microscopic view only.…”

Section: Discussionmentioning

confidence: 99%

“…The advancement of endoscopic techniques in the past decade has improved the surgical management of cerebellopontine angle (CPA) tumors. [ 2 , 11 , 23 , 45 ] Endoscope-assisted microsurgery improves the ability to evaluate the extent of resection, achieve safe tumor resection, and reduces the risk of surgery-related morbidity. [ 2 ] Endoscope-assisted microsurgery has been well studied and applied for CPA tumors, microvascular decompression (MVD), and aneurysm surgery.…”

Section: Introductionmentioning

confidence: 99%

Endoscope-assisted microsurgical retrosigmoid approach to the lateral posterior fossa: Cadaveric model and a review of literature

Fouda

Jeelani

Gokoglu

et al. 2021

Surgical Neurology International

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Background: The advancement of endoscopic techniques in the past decade has improved the surgical management of cerebellopontine angle (CPA) tumors. Endoscope-assisted microsurgery improves the ability to evaluate the extent of resection, achieve safe tumor resection and reduce the risk of surgery-related morbidity. Methods: In this study, we used a cadaveric model to demonstrate a step by step endoscope-assisted microsurgery of the retrosigmoid approach to the lateral posterior fossa. Results: Retrosigmoid craniotomies were performed on four latex-injected cadaver heads (eight CPAs). Microsurgical exposures were performed to identify neurovascular structures in each segment. 0° and 30° rigid endoscope lenses were subsequently introduced into each corridor and views were compared in this manner. The endoscopic images were compared with the standard microscopic views to determine the degree of visualization with each technique. In each case, better visualization was provided by both the 0° and 30° endoscope lenses. Endoscopic views frequently clarified neurovascular relationships in obscured anatomic regions. Conclusion: Endoscope-assisted microsurgery could allow better visualization of various regions of the posterior fossa. Surgical planning for posterior fossa lesions should include consideration of this combined approach.

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“…Since October 2017, at the end of microsurgical resection, a 4-mm Flexible Video Endoscope (4-mm x 65cm, Karl Storz, GmbH, Tuttlingen, Germany) has been inserted in the surgical cavity, handled by the surgeon (8,9), in order to detect eventual tumor residues in the internal auditory canal (IAC). Endoscopicassisted microsurgical removal was performed in 23 patients out of 60.…”

Section: Methodsmentioning

confidence: 99%

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

Mastronardi

Campione

Boccacci

et al. 2021

Preprint

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Purpose Koos Grade IV vestibular schwannomas (VS) (maximum diameter >3cm) compress the brainstem and displace the fourth ventricle. Microsurgical resection with attention to the right balance between preservation of function and maximal tumour removal is the treatment of choice.Methods Our series consists of 60 consecutive patients with unilateral VS, operated on from December 2010 to July 2019. All patients underwent microsurgical removal via the retrosigmoid approach. The adherence of VS’ capsule to surrounding nervous structures and the excessive tendency of tumor to bleed during debulking, because of a redundant vascular architecture, was evaluated by reviewing video records. Microsurgical removal of tumor was classified as total (T), near-total (NT: residue<5%), subtotal (ST: residue 5-10%) or partial (P: residue>10%).Results Maximal mean tumor diameter was 3,97cm (SD±1,13; range 3,1-5,8cm). Preoperative severely impaired hearing or deafness (AAO-HNS Classes C-D) was present in 52 cases (86,7%). Total or NT resection was accomplished in 46 cases (76,7%), 65,8% in cases with and 95,4% without tight adhesion of capsule to nervous structures (p<0,001). Endoscopic-assisted microsurgical removal of VS in the IAC was performed in 23 patients: in these cases a T resection was obtained in 78,3% versus 45,9% of microsurgery only (p<0,001).The capsule of VS was tightly adherent to nervous structures in 63,3% of patients, whereas hypervascular high-bleeding tumors represented 56,7%. Hearing preservation was possible in 2 out of 8 patients with preoperative class B hearing. At last follow-up, 34 patients (56,7%) had a normal postoperative FN outcome (HBI), 9 (15,0%) were HBII, 8 (13,3%) HBIII, and 9 (15,0%) HBIV. Total-NT resection of solid and low-bleeding VS, without tight capsule adhesion was associated with better FN outcome. Mortality was zero; permanent complications were observed in 2 cases (diplopia, hydrocephalus), transient in 9.Conclusions Microsurgery of Koos Grade IV VS seems to be associated with more than acceptable functional results, with high rate of T and NT removal of tumor. Long-term FN results seem to be worse in patients with cystic Koos Grade IV VS, in cases with tight capsule adherences to nervous structures and in high-bleeding tumors.

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Flexible endoscopic assistance in the surgical management of vestibular schwannomas

Cited by 17 publications

References 33 publications

Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Endoscope-assisted microsurgical retrosigmoid approach to the lateral posterior fossa: Cadaveric model and a review of literature

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal

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Flexible endoscopic assistance in the surgical management of vestibular schwannomas

Cited by 17 publications

References 33 publications

Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Endoscope-assisted microsurgical retrosigmoid approach to the lateral posterior fossa: Cadaveric model and a review of literature

Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between&nbsp;Preservation of Function and Maximal Tumor Removal

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Koos Grade IV Vestibular Schwannomas: Considerations on a consecutive series of 60 cases. Searching for the Balance Between Preservation of Function and Maximal Tumor Removal