Technical Note - Neurosurgical Techniques

Acta Neurochirurgica

, Volume 155, Issue 4, pp 663-670

Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach as a minimally invasive surgical option for the treatment of medium to large vestibular schwannomas

  • Maurizio IacoangeliAffiliated withDepartment of Neurosurgery, Università Politecnica delle Marche, Umberto I General HospitalClinica di Neurochirurgia, Università Politecnica delle Marche Email author 
  • , Fabrizio SalvinelliAffiliated withDepartment of ENT surgery, Università Campus Biomedico
  • , Alessandro Di RienzoAffiliated withDepartment of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital
  • , Maurizio GladiAffiliated withDepartment of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital
  • , Lorenzo AlvaroAffiliated withDepartment of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital
  • , Fabio GrecoAffiliated withDepartment of ENT surgery, Università Campus Biomedico
  • , Massimiliano CarassitiAffiliated withDepartment of Anestesiology and Critical Care, Università Campus Biomedico
  • , Massimo ScerratiAffiliated withDepartment of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital

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Abstract

Background

Treatment of vestibular schwannomas presents many controversial aspects, from the indication to the selection of the best treatment option. In the era of stereotactic radiotherapy, microsurgery has to be competitive in terms of providing the best chances of functional preservation and complete tumor removal. The two most commonly used surgical approaches are the retrosigmoid suboccipital and the presigmoid translabyrinthine. We describe the endoscopy-assisted presigmoid retrolabyrinthine approach (EAPRA) aiming at combining the advantages of the retrosigmoid and translabyrinthine techniques.

Methods

For 2 years (from May 2009 to June 2011), the EAPRA was used to remove medium to large sporadic vestibular schwannomas in ten patients.

Results

Complete tumor removal was obtained in eight patients, postoperative transient facial nerve function impairment or worsening was observed in two, and one had hearing deterioration postoperatively. No threatening complications occurred after surgery, and the length of hospitalization was usually less than 10 days.

Conclusions

The EAPRA can provide direct access to the CPA along with labyrinthine complex conservation, allowing hearing function preservation and minimal cerebellar retraction. Endoscopic assistance is a crucial adjunct in the presigmoid retrolabyrinthine approach in order to address the limits imposed by labyrinthine complex preservation. It ensures complete visualization of the intracanalicular portion of the schwannoma, thus improving the rate of a radical tumor resection. The EAPRA could represent a valid surgical option in vestibular schwannoma surgery.

Keywords

Endoscopy Minimally invasive neurosurgery Presigmoid retrolabyrinthine approach Vestibular nerve schwannomna Hearing preservation Key-hole surgery