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Acta Neurochirurgica

, Volume 161, Issue 11, pp 2265–2269 | Cite as

Hearing preservation in vestibular schwannoma surgery via retrosigmoid transmeatal approach

  • Ken Matsushima
  • Michihiro KohnoEmail author
  • Nobuyuki Nakajima
How I Do it - Tumor - Schwannoma
Part of the following topical collections:
  1. Tumor – Schwannoma

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.

Keywords

Acoustic neuroma Cerebellopontine angle tumor Internal acoustic meatus Lateral suboccipital approach Neuromonitoring Skull base surgery 

Abbreviations

ABR

Auditory brainstem response

CN

Cranial nerve

CNAP

Cochlear nerve action potentials

CT

Computed tomography

MRI

Magnetic resonance imaging

SEP

Somatosensory evoked potential

Notes

Acknowledgments

We thank Ms. Miki Hioki and Mr. Yoshifumi Kawaguchi for their support as medical technologists.

Compliance with ethical standards

Informed consent

Informed consent was obtained from a participant included in this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Video 1

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)

References

  1. 1.
    Amano M, Kohno M, Nagata O, Taniguchi M, Sora S, Sato H (2011) Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery. Acta Neurochir 153:1059–1067 discussion 1067CrossRefGoogle Scholar
  2. 2.
    Kohno M, Sato H, Sora S, Miwa H, Yokoyama M (2011) Is an acoustic neuroma an epiarachnoid or subarachnoid tumor. Neurosurgery 68(4):1006–1016CrossRefGoogle Scholar
  3. 3.
    Kohno M, Sora S, Sato H, Shinogami M, Yoneyama H (2015) Clinical features of vestibular schwannomas in patients who experience hearing improvement after surgery. Neurosurg Rev 38(2):331–341 discussion 341CrossRefGoogle Scholar
  4. 4.
    Matsushima K, Kohno M, Nakajima N (2019) Retrosigmoid intradural temporal bone drilling for intrapetrous chondrosarcoma extending to cerebellopontine angle. World Neurosurg 122:28CrossRefGoogle Scholar
  5. 5.
    Matsushima K, Kohno M, Nakajima N, Ichimasu N (2019) Dorsally displaced facial nerve in retrosigmoid transmeatal approach for vestibular schwannoma: 3-dimensional operative video. World Neurosurg. 123:300CrossRefGoogle Scholar
  6. 6.
    Nejo T, Kohno M, Nagata O, Sora S, Sato H (2016) Dorsal displacement of the facial nerve in acoustic neuroma surgery: clinical features and surgical outcomes of 21 consecutive dorsal pattern cases. Neurosurg Rev 39(2):277–288CrossRefGoogle Scholar
  7. 7.
    Quiñones-Hinojosa A, Chang EF, Lawton MT (2006) The extended retrosigmoid approach: an alternative to radical cranial base approaches for posterior fossa lesions. Neurosurgery. 58(4 Suppl 2):ONS-208-214 discussion ONS-214Google Scholar
  8. 8.
    Sasaki T, Shono T, Hashiguchi K, Yoshida F, Suzuki SO (2009) Histological considerations of the cleavage plane for preservation of facial and cochlear nerve functions in vestibular schwannoma surgery. J Neurosurg 110(4):648–655CrossRefGoogle Scholar
  9. 9.
    Shao KN, Tatagiba M, Samii M (1993) Surgical management of high jugular bulb in acoustic neurinoma via retrosigmoid approach. Neurosurgery. 32(1):32–36 discussion 36-37CrossRefGoogle Scholar
  10. 10.
    Wanibuchi M, Fukushima T, Friedman AH, Watanabe K, Akiyama Y, Mikami T, Iihoshi S, Murakami T, Sugino T, Mikuni N (2014) Hearing preservation surgery for vestibular schwannomas via the retrosigmoid transmeatal approach: surgical tips. Neurosurg Rev 37(3):431–444 discussion 444CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Ken Matsushima
    • 1
  • Michihiro Kohno
    • 1
    Email author
  • Nobuyuki Nakajima
    • 1
  1. 1.Department of NeurosurgeryTokyo Medical UniversityTokyoJapan

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