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Flexible endoscopic assistance in the surgical management of vestibular schwannomas

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Abstract

Endoscopic-assisted techniques have extensively been applied to vestibular schwannoma (VS) surgery allowing to increase the extent of resection, minimize complications, and preserve facial nerve and auditory functions. In this paper, we retrospectively analyze the effectiveness of flexible endoscope in the endoscopic-assisted retrosigmoid approach for the surgical management of VS of various sizes. The authors conducted a retrospective analysis on 32 patients who underwent combined microscopic and flexible endoscopic resection of VS of various sizes over a period of 16 months. Flexible endoscopic-assisted retrosigmoid approach was performed in all cases, and in 6 cases, flexible and rigid endoscopic control were used in combination to evaluate the differences between the two surgical instruments. The surgical results were additionally compared with a previous case series of 141 patients operated for VS of various sizes without endoscopic assistance. Gross-total resection was achieved in 84% of the cases and near-total resection was accomplished in the rest of them. Excellent or good facial nerve function was observed in all except one case with a preoperative severe facial palsy. Hearing preservation surgery (HPS) was attempted in 11 cases and accomplished in 9 (81.8%). A tumor remnant was endoscopically identified in the fundus of the IAC in all cases (100%). Endoscopic assistance increased the rate of total removal and no intrameatal residual tumor was seen at radiological follow-up. Comparative analysis with a surgical cohort of patients operated with the sole microsurgical technique showed a significative association between endoscopic assistance and intracanalicular extent of resection. Combined microsurgical and flexible endoscopic assistance provides remarkable advantages in the pursuit of maximal safe resection of VS and preservation of facial nerve and auditory functions, minimizing the risk of post-operative complications.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL, 1, Roma, Roma, Italy

    Francesco Corrivetti, Guglielmo Cacciotti, Carlo Giacobbo Scavo, Raffaelino Roperto, Giovanni Stati & Luciano Mastronardi

  2. Federal Centre of Neurosurgery, Tyumen, Russian Federation

    Albert Sufianov

  3. Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Moscow, Russian Federation

    Albert Sufianov & Luciano Mastronardi

Authors
  1. Francesco Corrivetti
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  2. Guglielmo Cacciotti
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  3. Carlo Giacobbo Scavo
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  4. Raffaelino Roperto
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  5. Giovanni Stati
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  6. Albert Sufianov
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  7. Luciano Mastronardi
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Correspondence to Luciano Mastronardi.

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ESM 1

Surgical technique of IAC inspection by means of flexible endoscope. Residual tumor is detected in the fundus and further microsurgical dissection is necessary to accomplish complete resection. Picture-in-picture video is used to visualize simultaneously both endoscopic and microscopic video images (MP4 194982 kb)

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Corrivetti, F., Cacciotti, G., Scavo, C.G. et al. Flexible endoscopic assistance in the surgical management of vestibular schwannomas. Neurosurg Rev 44, 363–371 (2021). https://doi.org/10.1007/s10143-019-01195-0

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