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Is endoscopic inspection necessary to detect residual disease in acoustic neuroma surgery?

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Main goals

To analyze how and when the endoscope is used in vestibular schwannoma surgery and identify the benefits of using endoscopy in this type of surgery.

Background

It is currently unclear if there is any benefit from using an endoscope in vestibular schwannoma surgery so this retrospective analysis set out to study this.

Methods

All the patients who underwent vestibular schwannoma surgery at our clinic were included for all the vestibular schwannoma approaches taken. We studied when endoscopy was used during surgery and the goal of using endoscopy. Several pre- and postoperative factors were assessed such as complications, facial function, and hearing function in the case of techniques that allow hearing preservation.

Results

From January 2015 to September 2018, 280 patients underwent lateral skull base surgery. Of these, 112 were included in this study. The endoscope was used in all 112 patients, and in eight cases it was possible to identify residual disease using the endoscope to check the surgical field, and then to remove the disease under endoscopic view. Moreover, in two other cases, the endoscope was used to resolve a vasculoneural conflict between the anterior inferior cerebellar artery (AICA) loop and facial nerve in one case, and for deafferentation of the superior and inferior vestibular nerves in the second case. No major intraoperative complications occurred in our series. There was no statistically significant difference in postoperative facial nerve function between patients in whom the endoscope was used as a diagnostic tool and patients in whom it was used as an operative tool (p = 0.3152).

Conclusions

The endoscope may be useful, especially in surgical techniques where there is poor control of the internal auditory canal (IAC). An endoscopic support technique is strongly recommended to avoid residual disease, particularly in retrosigmoid and retrolabyrinthine approaches. Moreover, the recent introduction of the transcanal transpromontorial approach allows the endoscope to be used during all the procedures in patients affected by a vestibular schwannoma limited to the IAC or to support surgical procedures during an enlarged microscopic approach.

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References

  1. Goksu N et al (2005) Evaluation of the results of endoscope-assisted acoustic neuroma surgery through posterior fossa approach. ORL J Otorhinolaryngol Relat Spec 67(2):87–91

    Article  PubMed  Google Scholar 

  2. Goksu N, Bayazit Y, Kemaloglu Y (1999) Endoscopy of the posterior fossa and endoscopic dissection of acoustic neuroma. Neurosurg Focus 6(4):e15

    Article  CAS  PubMed  Google Scholar 

  3. Corrivetti F et al (2018) Flexible endoscopic-assisted microsurgical radical resection of intracanalicular vestibular schwannomas by a retrosigmoid approach: operative technique. World Neurosurg 115:229–233

    Article  PubMed  Google Scholar 

  4. Kumon Y et al (2012) Usefulness of endoscope-assisted microsurgery for removal of vestibular schwannomas. J Neurol Surg B Skull Base 73(1):42–47

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wackym PA et al (1999) Adjunctive use of endoscopy during acoustic neuroma surgery. Laryngoscope 109(8):1193–1201

    Article  CAS  PubMed  Google Scholar 

  6. Sun JQ, Sun JW (2013) Endoscope-assisted retrosigmoid keyhole approach for cerebellopontine angle: cadaveric study. Acta Otolaryngol 133(11):1154–1157

    Article  PubMed  Google Scholar 

  7. Setty P et al (2015) Endoscopic resection of vestibular schwannomas. J Neurol Surg B Skull Base 76(3):230–238

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kabil MS, Shahinian HK (2006) A series of 112 fully endoscopic resections of vestibular schwannomas. Minim Invasive Neurosurg 49(6):362–368

    Article  CAS  PubMed  Google Scholar 

  9. House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93(2):146–147

    Article  CAS  PubMed  Google Scholar 

  10. Koos WT, Spetzler RF, Lang J (1993) Color atlas of microsurgery. Thieme, New York

    Google Scholar 

  11. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg 1995;113(3):179–80

  12. Marchioni D et al (2015) Endoscopic transcanal corridors to the lateral skull base: initial experiences. Laryngoscope 125(Suppl 5):S1–S13

    Article  PubMed  Google Scholar 

  13. Chen BS, Roberts DS, Lekovic GP (2016) Endoscopic-assisted middle fossa craniotomy for resection of vestibular schwannoma. J Neurol Surg Rep 77(1):e001–e007

    Article  PubMed  Google Scholar 

  14. Presutti L et al (2014) Combined endoscopic-microscopic approach for vestibular schwannoma removal: outcomes in a cohort of 81 patients. Acta Otorhinolaryngol Ital 34(6):427–433

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Shahinian HK, Ra Y (2011) 527 fully endoscopic resections of vestibular schwannomas. Minim Invasive Neurosurg 54(2):61–67

    Article  CAS  PubMed  Google Scholar 

  16. Iacoangeli M et al (2013) Microsurgical endoscopy-assisted presigmoid retrolabyrinthine approach as a minimally invasive surgical option for the treatment of medium to large vestibular schwannomas. Acta Neurochir (Wien) 155(4):663–670

    Article  Google Scholar 

  17. Presutti L et al (2017) Expanded transcanal transpromontorial approach to the internal auditory canal: pilot clinical experience. Laryngoscope 127(11):2608–2614

    Article  PubMed  Google Scholar 

  18. Marchioni D et al (2018) Expanded transcanal transpromontorial approach: a novel surgical technique for cerebellopontine angle vestibular schwannoma removal. Otolaryngol Head Neck Surg 158(4):710–715

    Article  PubMed  Google Scholar 

  19. Hori T et al (2006) Endoscope-controlled removal of intrameatal vestibular schwannomas. Minim Invasive Neurosurg 49(1):25–29

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was not funded.

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Authors and Affiliations

  1. Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, piazzale Aristide Stefani, 1, 37126, Verona, Italy

    Daniele Marchioni, Luca Gazzini, Francesco Boaria & Alessia Rubini

  2. Neurosurgery Department, University Hospital of Verona, piazzale Aristide Stefani, 1, 37126, Verona, Italy

    Giampietro Pinna & Barbara Masotto

Authors
  1. Daniele Marchioni
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  2. Luca Gazzini
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  3. Francesco Boaria
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  4. Giampietro Pinna
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  5. Barbara Masotto
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  6. Alessia Rubini
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Corresponding author

Correspondence to Luca Gazzini.

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Conflict of interest

The present authors have no financial relationship to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. All the authors have read and approved the manuscript.

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Marchioni, D., Gazzini, L., Boaria, F. et al. Is endoscopic inspection necessary to detect residual disease in acoustic neuroma surgery?. Eur Arch Otorhinolaryngol 276, 2155–2163 (2019). https://doi.org/10.1007/s00405-019-05442-4

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  • DOI: https://doi.org/10.1007/s00405-019-05442-4

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