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.
This is a preview of subscription content, log in to check access.
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.
Browne JD, Fisch U (1992) Transotic approach to the cerebellopontine angle. Neurosurg Clin N Am 19:265–278CrossRefGoogle Scholar
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
Mangham CA (2005) Retrosigmoid versus middle fossa surgery for small vestibular schwannomas. Laryngoscope 114:1455–1461CrossRefGoogle Scholar
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
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
Arriaga MA, Lin J (2012) Translabyrinthine approach: indications, techniques, and results. Otolaryngol Clin North Am 45:399–415CrossRefPubMedGoogle Scholar
Gantz BJ, Fisch U (1983) Modified transotic approach to the cerebellopontine angle. Arch Otolaryngol 109:252–256CrossRefPubMedGoogle Scholar
House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147PubMedGoogle Scholar
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
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
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
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
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
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
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
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
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
Slattery WH, Francis S, House KC (2001) Perioperative morbidity of acoustic neuroma surgery. Otol Neurotol 22:895–902CrossRefPubMedGoogle Scholar