Abstract
Background
Advances in various diagnostic and/or treatment modalities, including radiological imaging, neuromonitoring, and microsurgical techniques, have resulted in treatments of vestibular schwannomas being aimed at preserving facial and hearing functions while achieving optimal tumor control.
Method
We describe our surgical technique for hearing preservation in vestibular schwannoma surgery.
Conclusion
The retrosigmoid transmeatal approach under continuous neuromonitoring (auditory brainstem response, cochlear nerve action potentials, and continuous facial nerve monitoring) enables gross-total resection of vestibular schwannomas, while preserving hearing and facial functions. Radiological assessment and microsurgical techniques, such as meticulous tumor dissection, are also essential for functional preservation with sufficient tumor removal.
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Abbreviations
- ABR:
-
Auditory brainstem response
- CN:
-
Cranial nerve
- CNAP:
-
Cochlear nerve action potentials
- CT:
-
Computed tomography
- MRI:
-
Magnetic resonance imaging
- SEP:
-
Somatosensory evoked potential
References
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Acknowledgments
We thank Ms. Miki Hioki and Mr. Yoshifumi Kawaguchi for their support as medical technologists.
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Informed consent was obtained from a participant included in this study.
Conflict of interest
The authors declare that they have no conflict of interest.
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Key Points
- Sufficient craniotomy and dural opening for minimizing cerebellar retraction
- Combination of ABR and CNAP for continuous and stable hearing assessment
- Early start of and careful observation of continuous facial nerve monitoring
- Safe transmeatal drilling with sufficient irrigation
- Electrically activated dissectors for safe and prompt facial nerve identification inside the internal acoustic meatus
- Subperineurial tumor dissection in a semi-sharp fashion
- Maximum resection of the intrameatal tumor to prevent later recurrence
- Intraoperative decision-making for a balance between maximum tumor resection and functional preservation based on neuromonitoring
- Microscopic dural closure to prevent postoperative cerebrospinal fluid leakage
- Careful follow-up examination, particularly in cases with intentional near-total removal for functional preservation
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This article is part of the Topical Collection on Tumor - Schwannoma
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This video shows hearing preservation surgery for a left vestibular schwannoma via the retrosigmoid transmeatal approach under ABR, CNAP, and continuous facial nerve monitoring. (MP4 237191 kb)
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Matsushima, K., Kohno, M. & Nakajima, N. Hearing preservation in vestibular schwannoma surgery via retrosigmoid transmeatal approach. Acta Neurochir 161, 2265–2269 (2019). https://doi.org/10.1007/s00701-019-04034-9
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DOI: https://doi.org/10.1007/s00701-019-04034-9