Vestibular schwannoma removal through expanded transcanal transpromontorial approach: a multicentric experience

Molinari, Giulia; Calvaruso, Federico; Presutti, Livio; Marchioni, Daniele; Alicandri‐Ciufelli, Matteo; Friso, Filippo; Fernandez, Ignacio Javier; Francoli, Pietro; Maro, Flavia Di

doi:10.1007/s00405-022-07682-3

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…For the surgical management of VSs, three main approaches can be utilized: the retrosigmoid, the translabyrinthine, and the middle fossa approach, or sometimes combinations or variations of these [1][2][3][4][5]. Besides these most widely used approaches, there are other combinations and variations that could be utilized in some selected cases, but with limited indications [6][7][8][9]. Factors such as the size and extension of the tumor and the patient's hearing status play crucial roles in the choice of surgical approach.…”

Section: Introductionmentioning

confidence: 99%

Two-Stage Surgical Management for Acutely Presented Large Vestibular Schwannomas: Report of Two Cases

Keles,

Ozaydin,

Erginoglu

et al. 2023

Brain Sciences

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The surgical management of vestibular schwannomas should be based on their presentation, neuro-imaging findings, surgeons’ expertise, and logistics. Multi-stage surgery can be beneficial for large-sized lesions with acute presentations. Herein, we highlighted the indications for two cases managed initially through the retrosigmoid and, subsequently, translabyrinthine approaches. The first case presented with acute balance and gait issues and a long history of hearing loss and blurred vision. Neuroimaging findings revealed a cerebellopontine angle lesion, resembling a vestibular schwannoma, with significant brainstem compression and hydrocephalus. Due to the rapidly deteriorating clinical status and large-sized tumor, we first proceeded with urgent decompression via a retrosigmoid approach, followed by gross total resection via a translabyrinthine approach two weeks later. The second case presented with gradually worsening dizziness and hemifacial numbness accompanied by acute onset severe headaches and hearing loss. Neuroimaging findings showed a large cerebellopontine angle lesion suggestive of a vestibular schwannoma with acute intratumoral hemorrhage. Given the acute clinical deterioration and large size of the tumor, we performed urgent decompression with a retrosigmoid approach followed by gross total resection through a translabyrinthine approach a week later. Post-surgery, both patients showed excellent recovery. When managing acutely presented large-sized vestibular schwannomas, immediate surgical decompression is vital to avoid permanent neurological deficits.

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Section: Introductionmentioning

confidence: 99%

Two-Stage Surgical Management for Acutely Presented Large Vestibular Schwannomas: Report of Two Cases

Keles,

Ozaydin,

Erginoglu

et al. 2023

Brain Sciences

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“…In 2013, an exclusive endoscopic transcanal transpromontorial approach was proposed, which over the years was proven to be successful in the removal of small VS (stage I-II according to Koos classification), attributed to its better optics and direct visualisation of all the structures in the IAC and CPA [3,4]. After this encouraging experience, the transcanal corridor was used frequently, enlarging the surgical window to the CPA and extending the indications to VS of Koos stage II-III (expanded transcanal transpromontorial approach) [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…In 2013, an exclusive endoscopic transcanal transpromontorial approach was proposed, which over the years was proven to be successful in the removal of small VS (stage I–II according to Koos classification), attributed to its better optics and direct visualisation of all the structures in the IAC and CPA [ 3 , 4 ]. After this encouraging experience, the transcanal corridor was used frequently, enlarging the surgical window to the CPA and extending the indications to VS of Koos stage II–III (expanded transcanal transpromontorial approach) [ 5 , 6 , 7 , 8 ]. Based on the low morbidity rate and good facial nerve preservation, this approach was described as very promising but not recommended if patients required a simultaneous cochlear implant (CI) placement, as proposed in the translabyrinthine approach.…”

Section: Introductionmentioning

confidence: 99%

Cochlear Implantation Following Transcanal Infrapromontorial Approach for Vestibular Schwannoma: A Case Series

et al. 2022

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Background: Cochlear implantation (CI) following endoscopic transcanal infrapromontorial vestibular schwannoma (VS) dissection is a feasible intervention in intracanalicular VS, with minimal extension into the cerebellopontine angle, but no audiologic results have ever been reported in the literature. Methods: From 2015 to 2021 in the Otorhynolaryngology Departments of Modena and Verona, three patients underwent this intervention. All were suffering from sporadic left-sided intracanalicular Koos I VS. Intraoperative electrically evoked auditory brainstem responses and electrophysiological measurements were performed before and after the placement of the electrode array, respectively. Since device activation one month after the surgery, each patient was followed up with audiometric tests, data logging, electrode impedance measurements and neural response telemetry performed at each scheduled fitting session at 15 days and 3, 6, 12 and 24 months. Results: Only in patient No. 3, an auditory benefit was observed and still evident even 36 months after activation. Impedances increased progressively in patient No. 1 and a benefit was never reported. Patient No. 2 left the follow-up for worsening comorbidities. Conclusions: CI following transcanal infrapromontorial VS resection is a beneficial intervention. The residual cochlear nerve after the tumour dissection and the course of electrophysiological measurements in the postoperative period were the main predictive factors for audiological outcomes.

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Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center

Fontana,

Sinosi,

Marchioni

et al. 2024

Eur Arch Otorhinolaryngol

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Vestibular schwannoma removal through expanded transcanal transpromontorial approach: a multicentric experience

Cited by 3 publications

References 23 publications

Two-Stage Surgical Management for Acutely Presented Large Vestibular Schwannomas: Report of Two Cases

Two-Stage Surgical Management for Acutely Presented Large Vestibular Schwannomas: Report of Two Cases

Cochlear Implantation Following Transcanal Infrapromontorial Approach for Vestibular Schwannoma: A Case Series

Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center

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