Flexible Endoscopic-Assisted Microsurgical Radical Resection of Intracanalicular Vestibular Schwannomas by a Retrosigmoid Approach: Operative Technique

Corrivetti, Francesco; Cacciotti, Guglielmo; Scavo, Carlo Giacobbo; Roperto, Raffaelino; Mastronardi, Luciano

doi:10.1016/j.wneu.2018.04.108

Cited by 14 publications

(5 citation statements)

References 17 publications

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“…The source of a VS recurrence might be a microscopic tumor remnant on the cranial nerves or in the fundus of the internal auditory canal (24). To address these possibilities, various attempts have been made to maximize the VS resection via a retrosigmoid or middle fossa approach; i.e., with endoscopy (28)(29)(30). However, in a previous retrospective study, Panigrahi et al found that the Ki-67 labeling index, rather than the extent of resection, was associated with VS recurrences (31).…”

Section: Discussion Vestibular Schwannoma Recurrences and Remnantsmentioning

confidence: 99%

Surgery After Surgery for Vestibular Schwannoma: A Case Series

et al. 2020

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ObjectiveWe retrospectively evaluated the oncological and functional effectiveness of revision surgery for recurrent or remnant vestibular schwannoma (rVS).MethodsWe included 29 consecutive patients with unilateral hearing loss (16 women; mean age: 42.2 years) that underwent surgery for rVS. Previous surgeries included gross total resections (GTRs, n=11) or subtotal resections (n=18); mean times to recurrence were 9.45 and 4.15 years, respectively. House–Brackmann (HB) grading of facial nerve (FN) weakness (grades II-IV) indicated that 22 (75.9%) patients had deep, long-lasting FN paresis (HB grades: IV-VI). The mean recurrent tumor size was 23.3 mm (range: 6 to 51). Seven patients had neurofibromatosis type 2.ResultsAll patients received revision GTRs. Fourteen small- to medium-sized tumors located at the bottom of the internal acoustic canal required the translabyrinthine approach (TLA); 12 large and small tumors, predominantly in the cerebellopontine angle, required the retrosigmoid approach (RSA); and 2 required both TLA and RSA. One tumor that progressed to the petrous apex required the middle fossa approach. Fifteen patients underwent facial neurorrhaphy. Of these, 11 received hemihypoglossal–facial neurorrhaphies (HHFNs); nine with simultaneous revision surgery. In follow-up, 10 patients (34.48%) experienced persistent deep FN paresis (HB grades IV-VI). After HHFN, all patients improved from HB grade VI to III (n=10) or IV (n=1). No tumors recurred during follow-up (mean, 3.46 years).ConclusionsAggressive microsurgical rVS treatment combined with FN reconstruction provided durable oncological and neurological effects. Surgery was a reasonable alternative to radiosurgery, particularly in facial neurorrhaphy, where it provided a one-step treatment.

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Section: Discussion Vestibular Schwannoma Recurrences and Remnantsmentioning

confidence: 99%

Surgery After Surgery for Vestibular Schwannoma: A Case Series

et al. 2020

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“…The course of FN was classified according to its position in relation to the tumor: anterior, anterior-inferior, anterior-superior, and dorsal 14 , 15 ; anterior and inferior and anterior-superior positions were classified as polar, whereas anterior and dorsal were classified as equatorial in relation to the mass. At the end of microsurgical resection, a flexible video endoscope (4 mm × 65 cm; Karl Storz, Tuttlingen, Germany) was inserted in the surgical cavity, handled by the surgeon, 16 , 17 to detect possible tumor residues in the internal auditory canal. The extent of tumor removal was classified as total, near-total (tumor residue <5%), subtotal (residue 5%–10%), and partial (residue >10%).…”

Section: Methodsmentioning

confidence: 99%

Hypervascularized Large Vestibular Schwannomas: Single-Center Experience in a Series of Forty Cases

Mastronardi

Campione

Boccacci

et al. 2023

World Neurosurgery: X

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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-Assisted Microsurgical Radical Resection of Intracanalicular Vestibular Schwannomas by a Retrosigmoid Approach: Operative Technique

Cited by 14 publications

References 17 publications

Surgery After Surgery for Vestibular Schwannoma: A Case Series

Surgery After Surgery for Vestibular Schwannoma: A Case Series

Hypervascularized Large Vestibular Schwannomas: Single-Center Experience in a Series of Forty Cases

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-Assisted Microsurgical Radical Resection of Intracanalicular Vestibular Schwannomas by a Retrosigmoid Approach: Operative Technique

Cited by 14 publications

References 17 publications

Surgery After Surgery for Vestibular Schwannoma: A Case Series

Surgery After Surgery for Vestibular Schwannoma: A Case Series

Hypervascularized Large Vestibular Schwannomas: Single-Center Experience in a Series of Forty Cases

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