Microsurgical Gross-Total Resection of an Intracanalicular-Cisternal (Koos-4) Vestibular Schwannoma via a Retrosigmoid Approach with intraoperative Endoscopic assistance.

2021 ◽  
Author(s):  
Juan M. Revuelta Barbero ◽  
Edoardo Porto ◽  
Eduardo J. Medina ◽  
David P. Bray ◽  
Tomas Garzon-Muvdi ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Total Resection ◽  
Endoscopic Assistance

scholarly journals Retrosigmoid Approach for Resection of Medium-Sized Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S284-S284
Author(s):  
Michael J. Link ◽  
Colin L. W. Driscoll ◽  
Yening Feng ◽  
Maria Peris-Celda ◽  
Christopher S. Graffeo
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Instructional Video ◽  
Hearing Level ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Pure Tone Average ◽  
Petrous Temporal Bone

Objectives This video was aimed to describe the relevant anatomy and key surgical steps of retrosigmoid approach for gross total resection of a medium-sized vestibular schwannoma (VS). Design The procedure is described in a surgical instructional video. Setting The surgery took place at a tertiary skull base referral center. Participant Patient is a 63-year-old woman who reported with nonserviceable hearing (Pure Tone Average 60 dB Hearing level, Word Recognition Score 45%), occasional tinnitus, and a VS in the left cerebellopontine angle (CPA), extending into internal auditory canal (IAC), measuring 1.7 cm parallel to the petrous temporal bone. Main Outcome Measures The VS was resected by retrosigmoid approach. Results The surgery results gross total resection of the VS with postoperative House–Brackmann grade 1 facial nerve function and no postoperative complications. Conclusion The retrosigmoid approach is a good strategy to remove VS involving the CPA and the IAC.The link to the video can be found at: https://youtu.be/B6K_UkrKitg.

scholarly journals Gross Total Resection of Large Cerebellopontine Angle Meningioma with a Supratentorial Extension via Retrosigmoid Approach with Suprameatal Drilling and Tentorial Sectioning

2018 ◽  
Vol 79 (S 05) ◽  
pp. S399-S401
Author(s):  
Sima Sayyahmelli ◽  
Adi Ahmetspahic ◽  
Mustafa Baskaya
Keyword(s):  
Surgical Resection ◽  
Cerebellopontine Angle ◽  
Surgical Techniques ◽  
Retrosigmoid Approach ◽  
World Health ◽  
Gross Total Resection ◽  
Total Resection ◽  
Facial Numbness ◽  
Magnetic Resonance Imaging Mri ◽  
Health Organization

Meningiomas are the second most common neoplasm in the cerebellopontine angle (CPA), and are challenging lesions to treat surgically. With significant refinements in surgical techniques, operative morbidity, and mortality have been substantially reduced. Total or near-total surgical resection can be accomplished in the majority of cases via appropriately selected approaches, and with acceptable morbidity. In this video, we present a 51-year-old woman, who had a 2-year history of vertigo with symptoms that progressed over time. She presented with blurry vision, sensorineural hearing loss, tinnitus, left-sided facial numbness, and double vision. Magnetic resonance imaging (MRI) showed a left-sided homogeneously enhancing mass at CPA with a supratentorial extension. MRI appearance was consistent with a CPA meningioma with supratentorial extension. The patient underwent surgical resection via a retrosigmoid approach. Suprameatal drilling and tentorial sectioning were necessary to achieve gross total resection. The surgery and postoperative course were uneventful. The histopathology was a WHO (world health organization) grade I meningioma. MRI showed gross total resection of the tumor. After a 1.5-year follow-up, the patient is continuing to do well with no residual or recurrent disease. In this video, microsurgical techniques and important steps for the resection of this challenging meningioma of the cerebellopontine angle are demonstrated.The link to the video can be found at: https://youtu.be/CDto52GxrG4.

scholarly journals Microsurgical Gross Total Resection of a Large Residual/Recurrent Vestibular Schwannoma via Translabyrinthine Approach

2018 ◽  
Vol 79 (S 05) ◽  
pp. S387-S388
Author(s):  
Sima Sayyahmelli ◽  
Joseph Roche ◽  
Mustafa Baskaya
Keyword(s):  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Entry Zone ◽  
Stereotactic Radiation ◽  
Translabyrinthine Approach ◽  
History Of ◽  
Microsurgical Techniques ◽  
Facial Function

Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a translabyrinthine approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed.The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw.

scholarly journals Translabyrinthine Approach for Resection of Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S286-S286 ◽  
Author(s):  
Yening Feng ◽  
Neil S. Patel ◽  
Jamie J. Van Gompel ◽  
Matthew L. Carlson
Keyword(s):  
Vestibular Schwannoma ◽  
Severe Headache ◽  
Gross Total Resection ◽  
Instructional Video ◽  
Facial Nerve Function ◽  
Surgical Indications ◽  
Total Resection ◽  
Frequent Episodes ◽  
Patient Reported ◽  
Video Documents

Objectives This video describes the surgical indications, relevant anatomy, and surgical steps of routine translabyrinthine surgery for gross total resection of sporadic vestibular schwannoma. Design The procedure is presented through a surgical instructional video. Setting The surgery took place at tertiary skull base referral center. Parcipant A 47-year-old patient reported with nonserviceable hearing, frequent episodes of vertigo, recurrent severe headache, and a small unilateral right sided vestibular schwannoma. Results Gross total resection with preservation of facial nerve function was achieved. Conclusion This instructional video documents the surgical steps and relevant anatomy for translabyrinthine resection of vestibular schwannoma.The link to the video can be found at: https://youtu.be/CJ2vKMLs7aI.

Microsurgery for Recurrent Vestibular Schwannoma After Previous Gross Total Resection

2017 ◽  
Vol 38 (6) ◽  
pp. 882-888 ◽  
Author(s):  
Avital Perry ◽  
Christopher S. Graffeo ◽  
William R. Copeland ◽  
Matthew L. Carlson ◽  
Brian A. Neff ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Total Resection

Microsurgical Outcomes After Gross Total Resection on Vestibular Schwannoma in Elderly Patients: A Matched Cohort Study

2017 ◽  
Vol 101 ◽  
pp. 457-465 ◽  
Author(s):  
Nian Jiang ◽  
Zaibin Wang ◽  
Wen Chen ◽  
Yuanyang Xie ◽  
Zefeng Peng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Vestibular Schwannoma ◽  
Gross Total Resection ◽  
Matched Cohort ◽  
Total Resection ◽  
Matched Cohort Study

Vestibular schwannoma management

1998 ◽  
Vol 89 (6) ◽  
pp. 949-955 ◽  
Author(s):  
Bruce E. Pollock ◽  
L. Dade Lunsford ◽  
Douglas Kondziolka ◽  
Raymond Sekula ◽  
Brian R. Subach ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Surgical Resection ◽  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Gamma Knife Radiosurgery ◽  
Gross Total Resection ◽  
Total Resection ◽  
Content Type ◽  
Tumor Enlargement ◽  
Fine Print

Object. The indications, operative findings, and outcomes of vestibular schwannoma microsurgery are controversial when it is performed after stereotactic radiosurgery. To address these issues, the authors reviewed the experience at two academic medical centers. Methods. During a 10-year interval, 452 patients with unilateral vestibular schwannomas underwent gamma knife radiosurgery. Thirteen patients (2.9%) underwent delayed microsurgery at a median of 27 months (range 7–72 months) after they had undergone radiosurgery. Six of the 13 patients had undergone one or more microsurgical procedures before they underwent radiosurgery. The indications for surgery were tumor enlargement with stable symptoms in five patients, tumor enlargement with new or increased symptoms in five patients, and increased symptoms without evidence of tumor growth in three patients. Gross-total resection was achieved in seven patients and near-gross-total resection in four patients. The surgery was described as more difficult than that typically performed for schwannoma in eight patients, no different in four patients, and easier in one patient. At the last follow-up evaluation, three patients had normal or near-normal facial function, three patients had moderate facial dysfunction, and seven had facial palsies. Three patients were incapable of caring for themselves, and one patient died of progression of a malignant triton tumor. Conclusions. Failed radiosurgery in cases of vestibular schwannoma was rare. No clear relationship was demonstrated between the use of radiosurgery and the subsequent ease or difficulty of delayed microsurgery. Because some patients have temporary enlargement of their tumor after radiosurgery, the need for surgical resection after radiosurgery should be reviewed with the neurosurgeon who performed the radiosurgery and should be delayed until sustained tumor growth is confirmed. A subtotal tumor resection should be considered for patients who require surgical resection of their tumor after vestibular schwannoma radiosurgery.

scholarly journals Contralateral interhemispheric transfalcine approach to precuneal glioblastoma: fluorescein guided microsurgical resection and endoscopic microinspection tool

2022 ◽  
Vol 6 (1) ◽  
pp. V11
Keyword(s):  
Survival Benefit ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Total Resection ◽  
Link Type ◽  
Endoscopic Assistance ◽  
Microsurgical Resection ◽  
Areas Of Concern ◽  
Visualization Techniques ◽  
Intraoperative Visualization

Maximum safe resection remains a primary goal in the treatment of glioblastoma, with gross-total resection conveying additional survival benefit. Multiple intraoperative visualization techniques have been developed to improve the extent of resection. Herein, the authors describe the use of fluorescein and endoscopic assistance with a novel microinspection device in achieving a gross-total resection of a deep seated precuneal glioblastoma. An interhemispheric transfalcine approach was utilized and microsurgical resection was completed with fluorescein guidance. A 45° endoscope was then used to inspect the resection bed, and remaining areas of concern were then resected under endoscopic visualization. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21195

scholarly journals Retrosigmoid Approach for Resecting a Giant Lateral Pontine Ependymoma: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Hongxiang Wang ◽  
Yong Yan ◽  
Tao Xu ◽  
Juxiang Chen
Keyword(s):  
Brain Stem ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Neurological Deficits ◽  
Ependymal Cells ◽  
Total Resection ◽  
Petrosal Vein ◽  
Cerebellar Artery

AbstractEpendymoma is one of the most common pediatric tumors in central nervous system, for which gross total resection has been the most favorable prognostic factor.1 2 However, surgery of ependymomas located in brain stem is significantly challenging. This video demonstrates the microsurgical removal of an ependymoma originating from ependymal cells of the lateral recess of fourth ventricle via retrosigmoid approach in an 11-year-old female. The patient presented with a 6-month history of continues headache and vomiting. On examination, she had a walking instability and an emaciated body. Neuroimaging revealed a right lateral pontine lesion extending to the cerebellopontine angle region. The patient underwent a suboccipital craniotomy, followed by excellent exposure for the tumor. Petrosal vein encased by the tumor mass and close adhesion of the tumor and the initial segments of facial and acoustic nerves adjoined brain stem could be seen operatively. While preserving trigeminal nerve, facial and acoustic nerves, posterior cranial nerves, anterior inferior cerebellar artery, labyrinth artery, posterior inferior cerebellar artery, and petrosal vein, gross total resection was achieved under the careful operation along arachnoid spaces together with intratumoral decompression. The patient tolerated the procedure well without any neurological deficits. Histological examination confirmed the tumor as an ependymoma (WHO II). The cytology measurement of the cerebrospinal fluid did not find any tumor cells. Postoperative computed tomography and magnetic resonance imaging scan depicted complete resection of the tumor, and adjuvant radiotherapy was recommended. She remained symptom-free without any evidence of recurrence during the follow-up period of 1 year. Informed consent was obtained from the patient.The link to the video can be found at: https://youtu.be/sZ9GhUeltwc.

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