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Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center

  • Head and Neck
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Abstract

Background

The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development.

Methods

This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I—II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7 months.

Results

We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6 months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully.

Conclusions

The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.

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Data availability

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Abbreviations

AAO-HNS:

American Academy of Otolaryngology-Head and Neck Surgery

CSF:

Cerebrospinal fluid

EndoTTA:

Endoscopic transcanalar transpromontorial approach

ExpTTA:

Expanded transcanalar transpromontorial approach

HB:

House-Brackmann grading system

ICU:

Intensive care unit

NIM:

Nerve monitoring system

MRI:

Magnetic resonance imaging

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy

    Vincenzo Fontana & F. A. Sinosi

  2. Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy

    D. Marchioni

  3. Posterior Cranial Fossa Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Civile Maggiore Verona, Verona, Italy

    B. Masotto

Authors
  1. Vincenzo Fontana
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  2. F. A. Sinosi
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  3. D. Marchioni
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  4. B. Masotto
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Contributions

Vincenzo Fontana, neurosurgeon: article conceptualization, data collecting, manuscript writing, literature review. Filippo Sinosi, neurosurgery resident: data collecting, manuscript writing, literature review. Daniele Marchioni, ENT surgeon: manuscript review, main intellectual content. Barbara Masotto, neurosurgeon: manuscript review, patient selection, main intellectual content.

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Correspondence to Vincenzo Fontana.

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Fontana, V., Sinosi, F.A., Marchioni, D. et al. Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center. Eur Arch Otorhinolaryngol 281, 2679–2690 (2024). https://doi.org/10.1007/s00405-024-08565-5

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