Skip to main content

Advertisement

SpringerLink
Log in

Vestibular schwannoma: care for soft tissues and subperineural dissection: how I do it

  • How I Do it - Tumor - Schwannoma
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Recognition of the right surgical cleavage plane of a vestibular schwannoma is mandatory to preserve the facial nerve function.

Method

We describe here our surgical technique that is focused on soft tissues preservation and on subperineural dissection, avoiding direct exposure of the acoustico-facial complex in order to preserve facial nerve function.

Conclusion

Soft tissue dissection helps in reducing patient’s postoperative discomfort. Meticulously keeping a subperineural plan of dissection enables to preserve facial nerve function while offering satisfying resection rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Campero A, Martins C, Rhoton A, Tatagiba M (2011) Dural landmark to locate the internal auditory canal in large and giant vestibular schwannomas: the Tübingen line. Neurosurgery. https://doi.org/10.1227/NEU.0b013e31821664c6

  2. Chibbaro S, Cebula H, Scibilia S, Spatola G, Todeschi J, Gubian A (2018) Retrosigmoid approach: investigating the role of a C-shaped skin incision and muscle flaps in improving functional outcome and reducing postoperative pain. World Neurosurg 111:e340–e347

    Article  Google Scholar 

  3. Kohno M, Sato H, Sora S, Miwa H, Yokoyama M (2011) Is an acoustic neuroma an epiarachnoid or subarachnoid tumor? Neurosurgery 68(4):1006–1017

    Article  Google Scholar 

  4. Lescanne E, François P, Bakhos D, Velut S, Robier A, Pollak A (2008) Vestibular schwannoma: dissection of the tumor and arachnoidal duplication. Otol Neurotol 29(7):989–994

    Article  Google Scholar 

  5. 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: clinical article. J Neurosurg 110(4):648–655

    Article  Google Scholar 

  6. Starnoni D, Giammattei L, Cossu G et al (2020) Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir 162(11):2595–2617

    Article  Google Scholar 

  7. Tomio R, Yoshida K, Kohno M, Kamamoto D, Mikami S (2016) The outermost “dura-like membrane” of vestibular schwannoma. Surg Neurol Int. https://doi.org/10.4103/2152-7806.185008

  8. Troude L, Boucekine M, Montava M, Lavieille J-P, Régis J-M, Roche P-H (2018) Adjunctive gamma knife surgery or wait and scan policy after optimal resection of large vestibular schwannomas: clinical and radiologic outcomes. World Neurosurg 118:e895–e905

    Article  Google Scholar 

  9. Vellutini EAS, Beer-Furlan A, Brock RS, Gomes MQT, Stamm A, Cruz OLM (2014) The extracisternal approach in vestibular schwannoma surgery and facial nerve preservation. Arq Neuropsiquiatr 72(12):925–930

    Article  Google Scholar 

Download references

Author information

Author notes

  1. L. Giammattei and T. Passeri contributed equally to this work.

Authors and Affiliations

  1. Neurosurgery Department, Lariboisiere University Hospital, Paris, France

    L. Giammattei, T. Passeri, S. Padovan & S. Froelich

Authors
  1. L. Giammattei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Passeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Padovan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Froelich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Giammattei.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Patient consent

The patient/next of kin/guardian has consented to the submission of the case report for submission to the journal.

Conflict of interest

The authors declare no competing interests.

Additional information

Key Points

• Adequate patient’s position

• Careful soft tissues dissection to minimize patient’s postoperative discomfort

• Early cisternal opening to obtain cerebellar relaxation

• Right plane of dissection identified early at the level of the porus acusticus and kept circumferentially under continuous irrigation

• Low intensity bipolar coagulation should be used only inside the VS

• Whenever difficulties in maintaining the plane are encountered, the surgeon should change the working area

• Direct visualization of the acoustic-facial complex is avoided

• IOM is mandatory to trace the FN position and the noise of the IOM indicated maneuvers that irritate the FN

• Tumor remnants should be left onto the FN in case of tight adherences

• Adequate counselling should include patient’s expectations and possible alternative therapeutic strategies

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Tumor - Schwannoma

Supplementary information

This video represents a step by step removal of a right vestibular schwannoma. (MP4 219 mb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giammattei, L., Passeri, T., Padovan, S. et al. Vestibular schwannoma: care for soft tissues and subperineural dissection: how I do it. Acta Neurochir 163, 2247–2251 (2021). https://doi.org/10.1007/s00701-021-04801-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-021-04801-7

Keywords

Search

Navigation