Complex Vestibular Schwannomas: Case Illustrations of Surgical Technique
Surgical approaches for the treatment of complex vestibular schwannoma (VS) cases are discussed with a case-based discussion. Subtotal resection or staged resection should be considered to minimize the risk of cranial nerve and/or other neural injury in complex cases. Complicating factors include anatomical variations such as a high-riding jugular bulb, a forward-riding sigmoid sinus which narrows the presigmoid exposure, small and/or contracted mastoid bone, a previously thrombosed or absent sigmoid sinus on the contralateral side. Additional factors may include cystic schwannomas, tumors with brainstem compression and associated hydrocephalus, comorbid diseases that complicate anesthesia, prior history of VS surgery or radiation therapy, and rapid tumor progression associated with intratumoral hemorrhage. We have discussed and provided examples of the surgical approaches and considerations for the treatment of complex vestibular schwannomas through five case illustrations. The surgical team should consider, especially when difficulties arise, if the surgery should be staged to improve surgical exposure, and/or if the surgery should be terminated without achieving total resection to reduce the potential of damage to the critical structures.
KeywordsAcoustic neuroma Vestibular schwannoma Internal acoustic canal Facial nerve Vestibulocochlear nerve Cerebellopontine angle Cystic schwannomas Translabyrinthine approach Retrosigmoid approach Middle fossa approach
Microsurgical resection of a right-sided cochlear schwannoma via transotic fallopian bridge approach: 2D operative video (ZIP 300740 kb)
Microsurgical resection of a left-sided vestibular schwannoma via staged retrosigmoid and translabyrinthine approach: 2D operative video (ZIP 1934880 kb)
Microsurgical resection of giant cystic vestibular schwannoma associated with hydrocephalus via translabyrinthine approach: 2D operative video (ZIP 465783 kb)
Microsurgical resection of vestibular schwannoma via staged translabyrinthine and retrosigmoid approach: 3D operative video (ZIP 2955200 kb)
Microsurgical resection of large hypervascular vestibular schwannoma via translabyrinthine approach: 3D operative video (ZIP 406223 kb)
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