Translabyrinthine and transtentorial removal of acoustic nerve tumors

King, T. T.; Morrison, A. W.

doi:10.3171/jns.1980.52.2.0210

Cited by 98 publications

(48 citation statements)

References 7 publications

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“…7,9) The incidence of facial nerve palsy was 80% for tumors greater than 2 cm in diameter. 11) The incidence of postoperative facial nerve paresis or paralysis was 46% for large tumors greater than 3 cm in diameter. 14) Tumor size is the most important predictor of facial nerve palsy.…”

Section: Facial Nerve Preservationmentioning

confidence: 99%

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Seol

Kim

Park

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. The extent of resection was classified as follows: gross total resection (GTR), near total resection (NTR), and subtotal resection (STR). Facial nerve function was graded using the modified House-Brackmann grade, and patients grouped into good (grades 1-2) and intermediate or poor (grades 3-6). Of the 116 patients, 26 (22%) underwent GTR, 32 (28%) NTR, and 58 (50%) STR. The recurrence rates were 3.8% (1/26 cases), 9.4% (3/32), and 27.6% (16/58) for GTR, NTR, and STR, respectively. GTR and NTR showed no statistically significant difference in terms of recurrence rate (p ＝ 0.620). However, recurrence was significantly less after NTR than STR (p ＝ 0.043). Immediately postoperative facial nerve function was good in 15.4% of patients after GTR, 40.6% after NTR, and 46.6% after STR. The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p ＝ 0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p ＝ 0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.

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Section: Facial Nerve Preservationmentioning

confidence: 99%

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Seol

Kim

Park

et al. 2006

Neurol. Med. Chir.(Tokyo)

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“…6). 21,30,37 Additional bone resection in the translabyrinthine approach increased access to the anterolateral brainstem and inferior clivus. However, the translabyrinthine approach sacrifices the labyrinth at the expense of hearing function.…”

Section: Surgical Approachesmentioning

confidence: 99%

“…3 Each differs in the extent of petrous bone resection and has been well described. 3,21,22,30,37,54,58 Progressively aggressive bone removal provides better anatomical exposure and increases surgical freedom. Nevertheless, the increase in exposure and surgical freedom comes at the expense of potentially increasing complication rates.…”

Section: Surgical Approachesmentioning

confidence: 99%

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Karampelas

Megerian³

et al. 2013

FOC

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Object Petroclival meningiomas remain a formidable challenge for neurosurgeons because of their location deep within the skull base and proximity to eloquent neurovascular structures. Various skull base approaches have been used in their treatment, and deciding which is the optimal one remains controversial. Attempts at achieving gross- or near-total resections are associated with an increased rate of morbidity and mortality. As adjunctive treatment options such as stereotactic radiosurgery have been developed and become widely available, there has been a trend toward accepting subtotal resections in an effort to minimize neurological morbidity. This paper reviews a recent series of patients with petroclival meningiomas and highlights current management trends and important considerations useful in surgical decision making. Methods The records of patients with large (> 3 cm) petroclival meningiomas surgically treated by the senior author over the past 5 years were reviewed. The clinical results are presented as examples of the surgical approaches available for approaching these tumors, and treatment options are reviewed. Results Of 196 meningiomas surgically treated during the study period, 8 lesions in 8 patients met the study criteria. Overall clinical results were excellent, with no death or major morbidity. Intracranial gross- or near-total resection (Simpson Grade 1, 2, or 3) was achieved in 5 patients (67%). New cranial nerve deficits occurred in 3 patients (37%) and were more common in patients in whom a subtotal resection was performed (2 of 3 cases). A variety of surgical approaches were used. Important considerations determining the best approach include the location of the tumor relative to the internal auditory canal, the presence of preoperative hearing loss, and the location of the tumor relative to the tentorium. Conclusions Achieving gross- or near-total resections of large petroclival meningiomas remains achievable and should be the primary goal of surgical treatment. A retrosigmoid craniotomy remains a workhorse surgical approach for most petroclival tumors of any size. Tumors that are medial to the internal auditory canal and span both middle and posterior cranial fossae are often best treated with a combined transpetrosal approach, which is especially true if there is a preoperative hearing deficit.

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“…Early additions to the standard translabyrinthine ap-proach included its combination with a suboccipital craniectomy 10,17 and, importantly, opening of the tentorium, as described by King 26 in 1970. The latter was a key step in the evolution of the modern petrosal approach, providing an expanded, combined supra-and infratentorial exposure.…”

Section: Early Workmentioning

confidence: 99%

Evolution of the posterior petrosal approach

Gross¹,

Tavanaiepour²,

Du³

et al. 2012

FOC

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In this article, the authors review the history of the posterior petrosal approach. The early foundation of the retrolabyrinthine lateral petrosectomy has its roots in the otolaryngology literature. These early approaches were limited in exposure by the tentorium superiorly and the sigmoid sinus posteriorly. Although the concept of a transtentorial approach was originally combined with a complete labyrinthectomy, Hakuba and colleagues described the expansive exposure afforded by sectioning the tentorium and superior petrosal sinus and mobilizing a skeletonized sigmoid sinus. This maneuver serves as the key step in allowing for the full, combined supra- and infratentorial exposure that the posterior petrosal approach provides. In contrast to Hakuba et al.'s approach, which used a partial labyrinthectomy, modern approaches often preserve the entire labyrinth (retrolabyrinthine approach). For added exposure, the latter can be combined with the anterior petrosal approach, allowing for the preservation of hearing and an enhanced view of the surgical target. The authors review the evolution of the petrosal approach and highlight its applicability.

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Translabyrinthine and transtentorial removal of acoustic nerve tumors

Cited by 98 publications

References 7 publications

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results

Evolution of the posterior petrosal approach

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