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European Archives of Oto-Rhino-Laryngology

, Volume 273, Issue 5, pp 1115–1121 | Cite as

Decision making in dissection range of temporal bone: refinements to enlarged translabyrinthine approach

  • Zheng Jie Zhu
  • Wei Dong Zhu
  • Hong Sai Chen
  • Zhao Yan WangEmail author
  • Hao WuEmail author
Otology

Abstract

The aim of the study was to describe the refinements to the classic enlarged translabyrinthine approach (ETLA) by modifying the bony dissection range of temporal bone and to analyze the main outcomes achieved in a series of vestibular schwannoma (VS) cases submitted to microsurgery by ETLA. This was a retrospective study of 382 patients who underwent VS surgical removal via ETLA between January 2001 and December 2012. Among those cases, 332 were via classic ETLA, while 28 cases were via ETLA with blind sac technique and middle ear eradication and 22 via transotic approach. Total tumor removal was achieved in 368 cases, whereas near total removal in 11 patients and subtotal in 3 patients. In cases of large VS (>3 cm) via classic ETLA, good short-term and long-term facial nerve function (HB I–II) was gained in 27.8 % (32/115) and 42.6 % (49/115) cases, respectively, meanwhile in VS operated via blind sac technique, good short-term (p = 0.048) and long-term (p = 0.044) facial nerve function was reached in 44.0 % (22/50) and 60.0 % (30/50) cases, respectively. Postoperative facial nerve function was proved to be better in modified ETLA group. CSF leakage occurred in 16 (4.2 %) patients via classic ETLA. In 115 cases of large VS (>3 cm), postoperative CSF leakage occurred in 10 (8.7 %) patients. Whereas in 50 cases via blind sac technique, none developed CSF leakage (p = 0.03). The incidence of CSF leakage was lower in modified ETLA group. Our refinements to classic ETLA by changing the temporal bone resection range provide a wide surgical field, well prevention of CSF leakage and preservation of facial nerve function in large VS.

Keywords

Acoustic neuroma Vestibular schwannoma Enlarged translabyrinthine approach Facial nerve function Surgical complications 

Notes

Acknowledgment

This work was supported by the National Natural Science Foundation of China (NO. 81371086) to WANG Zhao yan.

Conflict of interest

No author has financial or other contractual agreements that might cause conflicts of interests.

References

  1. 1.
    Browne JD, Fisch U (1992) Transotic approach to the cerebellopontine angle. Neurosurg Clin N Am 19:265–278CrossRefGoogle Scholar
  2. 2.
    Angeli RD, Piccirillo E, Di Trapani G, Sequino G, Taibah A, Sanna M (2011) Enlarged translabyrinthine approach with transapical extension in the management of giant vestibular schwannomas: personal experience and review of literature. Otol Neurotol 32:125–131CrossRefPubMedGoogle Scholar
  3. 3.
    Mangham CA (2005) Retrosigmoid versus middle fossa surgery for small vestibular schwannomas. Laryngoscope 114:1455–1461CrossRefGoogle Scholar
  4. 4.
    Ben Ammar M, Piccirillo E, Topsakal V, Taibah A, Sanna M (2012) Surgical results and technical Refinements in translabyrinthine excision of vestibular schwannomas: the Gruppo Otologico experience. Neurosurgery 70:1481–1491CrossRefPubMedGoogle Scholar
  5. 5.
    Nickele CM, Akture E, Gubbels SP, Baskaya MK (2012) A stepwise illustration of the translabyrinthine approach to a large cystic vestibular schwannoma. Neurosurg Focus 33:E11CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Arriaga MA, Lin J (2012) Translabyrinthine approach: indications, techniques, and results. Otolaryngol Clin North Am 45:399–415CrossRefPubMedGoogle Scholar
  7. 7.
    Gantz BJ, Fisch U (1983) Modified transotic approach to the cerebellopontine angle. Arch Otolaryngol 109:252–256CrossRefPubMedGoogle Scholar
  8. 8.
    House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147PubMedGoogle Scholar
  9. 9.
    Tringali S, Ferber-viart C, Gallego S, Dubreuil C (2009) Hearing preservation after translabyrinthine approach performed to remove a large vestibular schwannoma. Eur Arch Otorhinolaryngol 266:147–150CrossRefPubMedGoogle Scholar
  10. 10.
    Anderson DE, Leonetti J, Wind JJ, Cribari D, Fahey K (2005) Resection of large vestibular schwannomas: facial nerve preservation in the context of surgical approach and patient-assessed outcome. J Neurosurg 102:643–649CrossRefPubMedGoogle Scholar
  11. 11.
    Patni AH, Kartush JM (2005) Staged resection of large acoustic neuromas. Otolaryngol Head Neck Surg 132:11–19CrossRefPubMedGoogle Scholar
  12. 12.
    Thomsen J, Tos M, Borgesen S, Moller H (1991) Surgical results after translabyrinthine removal of 504 acoustic neuromas. First International Conference on Acoustic Neuroma Copenhagen, Kugler Publications, Denmark, pp 331–335Google Scholar
  13. 13.
    Glasscock ME III, Kveton JF, Jackson CG, Levine SC, McKennan KX (1986) A systematic approach to the surgical management of acoustic neuroma. Laryngoscope 96:1088–1094CrossRefPubMedGoogle Scholar
  14. 14.
    Sluyter S, Graamans K, Tulleken CA, Van Veelen CW (2001) Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine–transtentorial approach. J Neurosurg 94:61–66CrossRefPubMedGoogle Scholar
  15. 15.
    Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–23PubMedGoogle Scholar
  16. 16.
    Khrais TH, Falcioni M, Taibah A, Agarwal M, Sanna M (2004) Cerebrospinal fluid leak prevention after translabyrinthine removal of vestibular schwannoma. Laryngoscope 114:1015–1020CrossRefPubMedGoogle Scholar
  17. 17.
    Merkus P, Taibah A, Sequino G, Sanna M (2010) Less than 1% cerebrospinal fluid leakage in 1,803 translabyrinthine vestibular schwannoma surgery cases. Otol Neurotol 31:276–283CrossRefPubMedGoogle Scholar
  18. 18.
    Darrouzet V, Martel J, Enee V, Bebear JP, Guerin J (2004) Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years. Laryngoscope 114:681–688CrossRefPubMedGoogle Scholar
  19. 19.
    Slattery WH, Francis S, House KC (2001) Perioperative morbidity of acoustic neuroma surgery. Otol Neurotol 22:895–902CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Otolaryngology Head and Neck Surgery, School of Medicine, Xinhua HospitalShanghai Jiaotong UniversityShanghaiChina
  2. 2.School of Medicine, Ear InstituteShanghai Jiaotong UniversityShanghaiChina

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