The translabyrinthine approach for the removal of large acoustic neuromas

1989 ◽  
Vol 246 (5) ◽  
pp. 292-296 ◽  
Author(s):  
M. Tos ◽  
J. Thomsen
Keyword(s):  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Translabyrinthine Approach for Acoustic Neuroma

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 391-396 ◽  
Author(s):  
John Diaz Day ◽  
Douglas A. Chen ◽  
Moises Arriaga
Keyword(s):  
Surgical Treatment ◽  
Acoustic Neuroma ◽  
Cerebellopontine Angle ◽  
Hearing Preservation ◽  
Retrosigmoid Approach ◽  
The Past ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Abstract THE TRANSLABYRINTHINE APPROACH has been popularized during the past 30 years for the surgical treatment of acoustic neuromas. It serves as an alternative to the retrosigmoid approach in patients when hearing preservation is not a primary consideration. Patients with a tumor of any size may be treated by the translabyrinthine approach. The corridor of access to the cerebellopontine angle is shifted anteriorly in contrast to the retrosigmoid approach, resulting in minimized retraction of the cerebellum. Successful use of the approach relies on a number of technical nuances that are outlined in this article.

Transmastoid extracranial repair of CSF leaks following acoustic neuroma resection

1989 ◽  
Vol 103 (9) ◽  
pp. 842-844 ◽  
Author(s):  
A. K. Robson ◽  
P. M. Clarke ◽  
M. Dilkes ◽  
A. R. Maw
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Management ◽  
Acoustic Neuroma ◽  
Complete Resolution ◽  
Sternomastoid Muscle ◽  
Translabyrinthine Approach ◽  
Suboccipital Craniectomy ◽  
Acoustic Neuromas ◽  
Good Access ◽  
Csf Leaks

AbstractAcoustic neuromas may be resected either by a suboccipital craniectomy or translabyrinthine approach; the latter gives good access without unduly traumatising the brainstem, but can lead to a higher incidence of cerebrospinal fluid (CSF) leaks. The surgical management of these leaks can be difficult; we describe a transmastoid extracranial technique using pedicled sternomastoid muscle that has produced complete resolution of the leak in all cases managed in this way.

scholarly journals Translabyrinthine Approach for Resection of Large Cystic Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

2019 ◽  
Vol 80 (S 03) ◽  
pp. S267-S268
Author(s):  
James K. Liu ◽  
Vincent N. Dodson ◽  
Robert W. Jyung
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Extracapsular Dissection ◽  
Cerebellar Retraction

The translabyrinthine approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a translabyrinthine approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the translabyrinthine approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function.The link to the video can be found at: https://youtu.be/zld2cSP8fb8.

scholarly journals Retractorless translabyrinthine approach for resection of a large acoustic neuroma: operative video and technical nuances

2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu ◽  
Robert W. Jyung
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Tumor Resection ◽  
Fat Graft ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Nerve Preservation ◽  
Facial Nerve Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Large acoustic neuromas, greater than 3 cm, can be technically challenging tumors to remove because of their intimate relationship with the brainstem and surrounding cranial nerves. Successful tumor resection involves functional preservation of the facial nerve and neurovascular structures. The translabyrinthine approach is useful for surgical resection of acoustic neuromas of various sizes in patients with poor preoperative hearing. The presigmoid surgical corridor allows direct exposure of the tumor in the cerebellopontine angle without any fixed cerebellar retraction. Early identification of the facial nerve at the fundus facilitates facial nerve preservation. Large acoustic tumors can be readily removed with a retractorless translabyrinthine approach using dynamic mobilization of the sigmoid sinus. In this operative video atlas report, the authors demonstrate their operative nuances for resection of a large acoustic neuroma via a translabyrinthine approach using a retractorless technique. Facial nerve preservation is achieved by maintaining a plane of dissection between the tumor capsule and the tumor arachnoid so that a layer of arachnoid protects the blood supply to the facial nerve. Multilayered closure is achieved with a fascial sling technique in which an autologous fascia lata graft is sutured to the dural defect to suspend the fat graft in the mastoidectomy defect. We describe the step-by-step technique and illustrate the operative nuances and surgical pearls to safely and efficiently perform the retractorless translabyrinthine approach, tumor resection, facial nerve preservation, and multi-layered reconstruction of the skull base dural defect to prevent postoperative cerebrospinal fluid leakage.The video can be found here: http://youtu.be/ros98UxqVMw.

Enlarged Translabyrinthine Approach for the Management of Large and Giant Acoustic Neuromas: A Report of 175 Consecutive Cases

2004 ◽  
Vol 113 (4) ◽  
pp. 319-328 ◽  
Author(s):  
Mario Sanna ◽  
Alessandra Russo ◽  
Maurizio Falcioni ◽  
Abdelkader Taibah ◽  
Manoj Agarwal
Keyword(s):  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach

1999 ◽  
Vol 6 (2) ◽  
pp. E1
Author(s):  
Todd H. Lanman ◽  
Derald E. Brackmann ◽  
William E. Hitselberger ◽  
Bill Subin
Keyword(s):  
Facial Nerve ◽  
Residual Tumor ◽  
Hearing Preservation ◽  
Cerebrospinal Fluid Leakage ◽  
Surgical Removal ◽  
Time Interval ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Total Tumor Removal ◽  
Functional Preservation

Object The choice of approach for surgical removal of large acoustic neuromas is still controversial. The authors reviewed the results in a series of patients who underwent removal of large tumors via the translabyrinthine approach. Methods The authors conducted a database analysis of 190 patients (89 men and 101 women) with acoustic neuromas 3 cm or greater in size. The mean age of these patients was 46.1 ± 15.6 years. One hundred seventy-eight patients underwent primary translabyrinthine surgical removal and 12 underwent surgery for residual tumor. Total tumor removal was accomplished in 183 cases (96.3%). The tumor was adherent to the facial nerve to some degree in 64% of the cases, but the facial nerve was preserved anatomically in 178 (93.7%) of the patients. Divided nerves were repaired by primary attachment or cable graft. Facial nerve function was assessed immediately after surgery, at the time of discharge, and at 3 to 4 weeks and 1 year after discharge. Excellent function (House-Brackmann facial nerve Grade I or II) was present in 55%, 33.9%, 38.8%, and 52.6% of the patients for each time interval, respectively, with acceptable function (Grades I–IV) in 81% at 1 year. Cerebrospinal fluid leakage that required surgical repair occurred in only 1.1% of the patients and meningitis occurred in 3.7%. There were no deaths. Conclusions Use of the translabyrinthine approach for removal of large tumors resulted in good anatomical and functional preservation of the facial nerve, with minimum incidence of morbidity and no incidence of mortality. The authors continue to recommend use of this approach for acoustic tumors larger than 3 cm and for smaller tumors when hearing preservation is not an issue.

scholarly journals The Transcranial Translabyrinthine Approach to Acoustic Neuromas

Skull Base ◽  
1994 ◽  
Vol 4 (03) ◽  
pp. 132-135
Author(s):  
Joseph G. Feghali ◽  
Allen B. Kantrowitz
Keyword(s):  
Translabyrinthine Approach ◽  
Acoustic Neuromas

An Algorithm for the Management of Acoustic Neuromas regarding Age, Hearing, Tumor Size, and Symptoms

1993 ◽  
Vol 108 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Herbert Silverstein ◽  
Seth I. Rosenberg ◽  
John M. Flanzer ◽  
Hayes H. Wanamaker ◽  
Michael D. Seidman
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Pure Tone ◽  
Hearing Preservation ◽  
Subtotal Resection ◽  
Residual Hearing ◽  
Pure Tone Average ◽  
The Past ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

An algorithm has evolved for the management of patients with acoustic neuroma. Decisions as to surgery vs. observation, surgical approach, and whether hearing preservation should be attempted depend on age, patient symptoms, size of the tumor, residual hearing, and degree of facial nerve involvement at the time of surgery. Conservative management is used for patients over 65 years of age. This consists of observation or subtotal resection through a translabyrinthine approach, depending on the absence or presence of brainstem signs or symptoms. In patients under 65 years of age, hearing preservation is attempted through the retrosigmoid approach in tumors 1.5 cm or less if pure-tone average is less than 30 dB and the discrimination score is greater than 70%. The translabyrinthine approach is our preferred approach for tumors of any size when hearing is not serviceable. A near-total excision is performed when the facial nerve cannot be separated from the tumor. The rationale for this algorithm in the management of 130 cases of acoustic neuroma over the past 17 years is presented.

Hearing Preservation Using the Modified Translabyrinthine Approach

1993 ◽  
Vol 108 (6) ◽  
pp. 671-679 ◽  
Author(s):  
John T. McElveen ◽  
Robert H. Wilkins ◽  
David W. Molter ◽  
Andrea C. Erwin ◽  
Robert D. Wolford
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Removal of an acoustic neuroma using the translabyrinthine approach has previously been considered “Incompatible” with hearing preservation. By modifying the approach and preventing the loss of endolymph, we have successfully removed two Intracanallcular acoustic neuromas that originated from the inferior vestibular nerves, and preserved serviceable hearing in the ears operated on. This report represents the preliminary findings using this particular technique in the management of Intracanallcular acoustic neuromas.

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