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A microscope-assisted endoscopic transcanal transpromontorial approach for vestibular schwannoma resection: a preliminary report

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

Abstract

Objective

To evaluate the feasibility of a microscope-assisted endoscopic transcanal transpromontorial approach (METTA) for the removal of small vestibular schwannomas (VS) limited to the internal auditory canal (IAC), and introduce a modification without external auditory canal (EAC) closure.

Methods

Between August 2018 and February 2019, seven patients with intrameatal VS underwent surgery in our center, endoscopic transcanal transpromontorial approach was applied in the first 2 patients and the rest 5 patients were operated via METTA. Treatment outcomes including efficacy of tumor resection, facial nerve outcome, operation time and post-operative course were recorded and analyzed.

Results

All seven patients were pathologically confirmed to have intrameatal VS. Total tumor removal was achieved in all cases. Two patients experienced cerebrospinal fluid leakage which resolved spontaneously within 5 days. The average operation time was 161.41 ± 18.42 min. All patients presented normal facial nerve function 1 month after surgery.

Conclusion

The METTA was effective in the removal of intrameatal VS. It can be an alternative surgical option for intrameatal VS with no serviceable hearing.

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References

  1. Stangerup SE, Tos M, Thomsen J et al (2010) True incidence of vestibular schwannoma? Neurosurgery 67(5):1335–1340

    Article  PubMed  Google Scholar 

  2. Stangerup SE, Tos M, Caye-Thomasen P et al (2004) Increasing annual incidence of vestibular schwannoma and age at diagnosis. J Laryngol Otol 118:622–627

    Article  PubMed  Google Scholar 

  3. Kondziolka D, Lunsford LD, McLaughlin MR et al (1998) Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426–1433

    Article  CAS  PubMed  Google Scholar 

  4. Stangerup SE, Caye-Thomasen P (2012) Epidemiology and natural history of vestibular schwannomas. Otolaryngol Clin North Am 45(2):257–268

    Article  PubMed  Google Scholar 

  5. Marchioni D, Alicandri-Ciufelli M, Rubini A et al (2017) Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment. J Neurosurg 126(1):98–105. https://doi.org/10.3171/2015.11.JNS15952

    Article  PubMed  Google Scholar 

  6. Samii M, Metwali H, Gerganov V (2017) Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms. J Neurosurg 126(5):1514–1519

    Article  PubMed  Google Scholar 

  7. Tos M, Thomsen J, Harmsen A (1988) Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size. Acta Otolaryngol Suppl 452:38–51

    Article  CAS  PubMed  Google Scholar 

  8. Schwartz MS, Lekovic GP, Miller ME et al (2018) Translabyrinthine microsurgical resection of small vestibular schwannomas. J Neurosurg 129(1):128–136

    Article  PubMed  Google Scholar 

  9. Thomassin JM, Korchia D, Doris JM (1993) Endoscopic-guided otosurgery in the prevention of residual cholesteatomas. Laryngoscope 103(8):939–943

    Article  CAS  PubMed  Google Scholar 

  10. Magnan J, Chays A, Lepetre C et al (1994) Surgical perspectives of endoscopy of the cerebellopontine angle. Am J Otol 15(3):366–370

    CAS  PubMed  Google Scholar 

  11. Presutti L, Alicandri-Ciufelli M, Cigarini E et al (2013) Cochlear schwannoma removed through the external auditory canal by a transcanal exclusive endoscopic technique. Laryngoscope 123(11):2862–2867

    Article  PubMed  Google Scholar 

  12. Moon IS, Cha D, Nam SI et al (2019) The feasibility of a modified exclusive endoscopic transcanal transpromontorial approach for vestibular schwannomas. J Neurol Surg B Skull Base 80(1):82–87

    Article  PubMed  Google Scholar 

  13. Marchioni D, Veronese S, Carner M et al (2018) Hearing restoration during vestibular schwannoma surgery with transcanal approach: anatomical and functional preliminary report. Otol Neurotol 39(10):1304–1310

    Article  PubMed  Google Scholar 

  14. Marchioni D, Soloperto D, Masotto B et al (2018) Transcanal transpromontorial acoustic neuroma surgery: results and facial nerve outcomes. Otol Neurotol 39(2):242–249

    Article  PubMed  Google Scholar 

  15. Bennett M, Haynes DS (2007) Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin North Am 40:589–609

    Article  PubMed  Google Scholar 

  16. Wick CC, Arnaoutakis D, Barnett SL et al (2017) Endoscopic transcanal transpromontorial approach for vestibular schwannoma resection: a case series. Otol Neurotol 38(10):e490–e494

    Article  PubMed  Google Scholar 

  17. Kozin ED, Lehman A, Carter M et al (2014) Thermal effects of endoscopy in a human temporal bone model: implications for endoscopic ear surgery. Laryngoscope 124:E322–E329

    Article  Google Scholar 

  18. Presutti L, Alicandri-Ciufelli M, Bonali M et al (2017) Expanded transcanal transpromontorial approach to the internal auditory canal: pilot clinical experience. Laryngoscope 127(11):2608–2614. https://doi.org/10.1002/lary.26559

    Article  PubMed  Google Scholar 

Download references

Funding

This research was supported by grants from “Star of Jiaotong University” program of Shanghai Jiaotong University (YG2019QN) and “Technology Innovation Action Plan” of Shanghai Science and Technology Commission (17441902800).

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Authors

Contributions

CJ and CY contributed equally to this work.

Corresponding authors

Correspondence to Wang Zhaoyan or Wu Hao.

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The authors declare that they have no conflicts of interests.

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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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The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

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Jianqing, C., Yongchuan, C., Zhihua, Z. et al. A microscope-assisted endoscopic transcanal transpromontorial approach for vestibular schwannoma resection: a preliminary report. Eur Arch Otorhinolaryngol 279, 75–82 (2022). https://doi.org/10.1007/s00405-021-06612-z

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  • DOI: https://doi.org/10.1007/s00405-021-06612-z

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