scholarly journals Surgical Strategy in Large Vestibular Schwannoma

2018 ◽  
Vol 80 (S 03) ◽  
pp. S272-S273
Author(s):  
Georgios Klironomos ◽  
Amir Reza Dehdashti
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Air Embolism ◽  
Patient Positioning ◽  
Skin Incision ◽  
Surgical Strategy ◽  
Vestibular Schwannomas ◽  
Magnetic Resonance Imaging Mri ◽  
Large Vestibular Schwannoma

Particular care to facial nerve function preservation should be the ultimate goal in surgery for large vestibular schwannomas. We present a 60-year-old patient who presented with an enlarging right vestibular schwannoma and nonserviceable hearing. The patient was operated in the semisitting position after a patent foramen ovale was ruled out. During the positioning, the feet were positioned at the level of the heart. Precordial Doppler was used to monitor for air embolism. Straight skin incision and retrosigmoid craniotomy was performed. Specific attention to venous bleeding was made during the approach. Meticulous arachnoid dissection of the capsule preserving the arachnoid plane at the surface of the brain stem and the facial nerve can be achieved more efficiently with the patient in the semisiting position and with bimanual microdissection technique. After drilling of the internal auditory canal (IAC), we were able to achieve near total removal of the tumor, leaving a tiny tumor carpet due to extreme adherence to the nerve. Water-tight dura closure and replacement of the bone flap was performed. The patient woke up with a House–Brackmann grade III facial weakness which improved to grade I at 6 weeks postoperatively. Postoperative magnetic resonance imaging (MRI) showed a tiny residual at the surface of the facial nerve at the entrance of the IAC. Near total (> 98%) resection of large vestibular schwannomas is an acceptable surgical strategy with excellent facial nerve outcome. With appropriate patient positioning in semisitting and proper anesthesiological and surgical management, the risk of air embolism is negligible.The link to video can be found at: https://youtu.be/ErG9VexbiGw.

Spreading of the vestibular schwannoma into porus acusticus internus. Endoscopic removal possibilities

2018 ◽  
pp. 40-44
Author(s):  
Orest Palamar ◽  
Andriy Huk ◽  
Dmytro Okonskyi ◽  
Ruslan Aksyonov ◽  
Dmytro Teslenko
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Residual Tumor ◽  
Endoscopic Technique ◽  
Vestibular Schwannomas ◽  
Endoscopic Removal ◽  
Tumor Removal ◽  
Tumor Spread ◽  
Microsurgical Technique ◽  
Tumor Visualization

Aim: To investigate the features of the vestibular schwannoma spread into the internal auditory canal and the possibilities of endoscopic removal. Objectives: To improve tumor visualization in the internal auditory canal; to create a sufficient view angle for tumor removal during endoscopic opening of the internal auditory canal. Materials and methods: The results of surgical treatment of 20 patients with vestibular schwannomas in which the tumor spread to the internal auditory canal were analyzed. Microsurgical tumor removal was performed in 14 cases; Fully endoscopic removal of vestibular schwannomas was performed in 6 cases. The internal auditory canal opening was performed in 14 cases using microsurgical technique and in 6 cases with fully the endoscopic technique. Results: Gross total removal was achieved in 18 cases, subtotal removal in 2 cases. The tumor spread into the internal auditory canal was removed in all cases (100%). Opening the internal auditory canal using the endoscopic technique allows to increase the view angle (up to 20%) and to visualize along the axis of canal. Conclusions: 1) Endoscopic assistance technique allows to improve residual tumor visualization much more better then microsurgical technique; 2) Internal auditory canal opening using endoscopic technique is much more effective than the microsurgical technique (trepanning depth is larger); 3) Endoscopic methods for the internal auditory canal opening allows to increase canal angle view up to 20% (comparing to the microsurgical view).

scholarly journals Sensitivity and Negative Predictive Value of Motor Evoked Potentials of the Facial Nerve

2021 ◽  
Author(s):  
Nicolas Bovo ◽  
Shahan Momjian ◽  
Renato Gondar ◽  
Philippe Bijlenga ◽  
Karl Schaller ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Evoked Potentials ◽  
Negative Predictive Value ◽  
Patient Group ◽  
Vestibular Schwannoma ◽  
Predictive Value ◽  
Cerebellopontine Angle ◽  
Motor Evoked Potentials ◽  
Vestibular Schwannomas ◽  
Predictive Values

Abstract Objective The objective of this study was to determine the performance of the standard alarm criterion of motor evoked potentials (MEPs) of the facial nerve in surgeries performed for resections of vestibular schwannomas or of other lesions of the cerebellopontine angle. Methods This retrospective study included 33 patients (16 with vestibular schwannomas and 17 with other lesions) who underwent the resection surgery with transcranial MEPs of the facial nerve. A reproducible 50% decrease in MEP amplitude, resistant to a 10% increase in stimulation intensity, was applied as the alarm criterion during surgery. Facial muscular function was clinically evaluated with the House–Brackmann score (HBS), pre- and postsurgery at 3 months. Results In the patient group with vestibular schwannoma, postoperatively, the highest sensitivity and negative predictive values were found for a 30% decrease in MEP amplitude, that is, a criterion stricter than the 50% decrease in MEP amplitude criterion, prone to trigger more warnings, used intraoperatively. With this new criterion, the sensitivity would be 88.9% and the negative predictive value would be 85.7%. In the patient group with other lesions of the cerebellopontine angle, the highest sensitivity and negative predictive values were found equally for 50, 60, or 70% decrease in MEP amplitude. With these criteria, the sensitivities and the negative predictive values would be 100.0%. Conclusion Different alarm criteria were found for surgeries for vestibular schwannomas and for other lesions of the cerebellopontine angle. The study consolidates the stricter alarm criterion, that is, a criterion prone to trigger early warnings, as found previously by others for vestibular schwannoma surgeries (30% decrease in MEP amplitude).

scholarly journals Diamond knife dissection technique for nerve preservation during resection of large vestibular schwannomas

2021 ◽  
Vol 5 (2) ◽  
pp. V8
Author(s):  
Julia Shawarba ◽  
Cand Med ◽  
Matthias Tomschik ◽  
Karl Roessler
Keyword(s):  
Vestibular Schwannoma ◽  
Facial Nerve Palsy ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Nerve Preservation ◽  
Dissection Techniques ◽  
Dissection Technique ◽  
Large Vestibular Schwannoma ◽  
Facial Function ◽  
Diamond Knife

Facial and cochlear nerve preservation in large vestibular schwannomas is a major challenge. Bimanual pincers or plate-knife dissection techniques have been described as crucial for nerve preservation. The authors demonstrate a recently applied diamond knife dissection technique to peel the nerves from the tumor capsule. This technique minimizes the nerve trauma significantly, and complete resection of a large vestibular schwannoma without any facial nerve palsy and hearing preservation is possible. The authors illustrate this technique during surgery of a 2.6-cm vestibular schwannoma in a 27-year-old male patient resulting in normal facial function and preserved hearing postoperatively. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21104

scholarly journals Translabyrinthine microsurgical resection of small vestibular schwannomas

2018 ◽  
Vol 129 (1) ◽  
pp. 128-136 ◽  
Author(s):  
Marc S. Schwartz ◽  
Gregory P. Lekovic ◽  
Mia E. Miller ◽  
William H. Slattery ◽  
Eric P. Wilkinson
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Sinus Thrombosis ◽  
Treatment Options ◽  
Previous Treatment ◽  
Cerebrospinal Fluid Leak ◽  
Neurofibromatosis Type ◽  
Additional Treatment ◽  
Vestibular Schwannomas ◽  
Tumor Control

OBJECTIVETranslabyrinthine resection is one of a number of treatment options available to patients with vestibular schwannomas. Though this procedure is hearing destructive, the authors have noted excellent clinical outcomes for patients with small tumors. The authors review their experience at a tertiary acoustic neuroma referral center in using the translabyrinthine approach to resect small vestibular schwannomas. All operations were performed by a surgical team consisting of a single neurosurgeon and 1 of 7 neurotologists.METHODSData from a prospectively maintained clinical database were extracted and reviewed. Consecutive patients with a preoperative diagnosis of vestibular schwannoma that had less than 1 cm of extension into the cerebellopontine angle, operated on between 2008 and 2013, were included. Patents with neurofibromatosis Type 2, previous treatment, or preexisting facial weakness were excluded. In total, 107 patients were identified, 74.7% of whom had poor hearing preoperatively.RESULTSPathologically, 6.5% of patients were found to have a tumor other than vestibular schwannoma. Excluding two malignancies, the tumor control rates were 98.7%, as defined by absence of radiographic disease, and 99.0%, as defined by no need for additional treatment. Facial nerve outcome was normal (House-Brackmann Grade I) in 97.2% of patients and good (House-Brackmann Grade I–II) in 99.1%. Complications were cerebrospinal fluid leak (4.7%) and sigmoid sinus thrombosis (0.9%), none of which led to long-term sequelae.CONCLUSIONSTranslabyrinthine resection of small vestibular schwannomas provides excellent results in terms of complication avoidance, tumor control, and facial nerve outcomes. This is a hearing-destructive operation that is advocated for selected patients.

Predictive Factors of Early Postoperative and Long-Term Facial Nerve Function After Large Vestibular Schwannoma Surgery

2019 ◽  
Vol 127 ◽  
pp. e599-e608 ◽  
Author(s):  
Lucas Troude ◽  
Mohamed Boucekine ◽  
Marion Montava ◽  
Jean-Pierre Lavieille ◽  
Jean-Marie Régis ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Predictive Factors ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Large Vestibular Schwannoma

Modified translabyrinthine approach and hearing preservation: imaging evaluation

2007 ◽  
Vol 121 (8) ◽  
pp. 736-741 ◽  
Author(s):  
G Magliulo ◽  
A Stasolla ◽  
D Parrotto ◽  
M Marini
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Ct Scans ◽  
Successful Outcome ◽  
Imaging Evaluation ◽  
Translabyrinthine Approach ◽  
Hearing Function ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

AbstractAim:To establish if the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of the vestibule, after the removal of vestibular schwannoma by a modified translabyrinthine approach, correlate with a successful outcome, defined as hearing preservation.Materials and methods:Our study group consisted of 16 patients with vestibular schwannoma. All patients' pre-operative hearing was graded as class one or two according to the Gardner–Robertson scale. On MRI scans, the schwannoma, including the intracanalicular segment, were less than 2 cm in size in all the patients. The intracanalicular portion involved the fundus of the internal auditory canal in seven patients. In the remaining nine patients, the schwannoma had spread to involve two-thirds of the meatus, sparing its lateral third. The state of the labyrinth, in particular the integrity of the vestibule, was evaluated by CT scans and MRI prior to and following surgery.Results:The schwannoma was completely removed in all patients. None showed any signs of persistence or tumoral relapse on the post-operative MRI. The final follow up showed that seven patients had maintained their hearing function (i.e. four patients with class one hearing and three with class two). The MRI vestibular signal on the T2-weighted images was well depicted only in patients with hearing preservation. Bony vestibular integrity was observed in the CT scans of all cases with hearing preservation, and also in three cases with failure of hearing preservation.Conclusion:Our results confirm that total isolation and maintenance of an anatomically intact vestibule, as depicted by MRI examination, is one of the fundamental factors for successful preservation of hearing function following modified translabyrinthine approach schwannoma removal.

Meningioma in the internal auditory canal

2001 ◽  
Vol 115 (1) ◽  
pp. 48-49 ◽  
Author(s):  
P. Martinez Devesa ◽  
M. J. Wareing ◽  
D. A. Moffat
Keyword(s):  
Magnetic Resonance Imaging ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Histological Examination ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Resonance Imaging ◽  
Translabyrinthine Approach ◽  
Magnetic Resonance Imaging Mri

A case is presented of an entirely intracanalicular meningioma in a 48-year-old woman that was excised via a conventional translabyrinthine approach to the internal auditory canal (IAC). Pre-operative magnetic resonance imaging (MRI) suggested that the tumour was a vestibular schwannoma (VS). Histological examination confirmed the intra-operative impression that the tumour was a meningioma. Although VS is by far the commonest intracanalicular tumour, the differential diagnosis includes meningioma. MRI is unable to distinguish between these two entities when the tumour is located entirely in the internal auditory canal.

scholarly journals Facial Nerve Schwannomas Mimicking as Vestibular Schwannomas

2017 ◽  
Vol 78 (04) ◽  
pp. 283-287
Author(s):  
Sean Wise ◽  
David Cohen ◽  
Jason Bell ◽  
Dennis Bojrab ◽  
Michael LaRouere ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Outcome Measures ◽  
Action Potentials ◽  
Internal Auditory Canal ◽  
Vestibular Schwannomas ◽  
Tumor Capsule ◽  
Spontaneous Action ◽  
The Mean ◽  
Spontaneous Action Potentials ◽  
Stimulation Of

Objective The objective of this study was to identify preoperative and intraoperative findings that may aid in distinguishing facial nerve schwannomas (FNS) from vestibular schwannomas (VSs), particularly in cases limited to the internal auditory canal (IAC) and cerebellopontine angle (CPA). Study Design This was a retrospective study. Setting This study was set at a Tertiary Referral Center. Patients Seventeen cases from October 2002 to July 2015 with an IAC/CPA mass presumed to be a VS who were found to have a FNS intraoperatively. Main Outcome Measures The main outcome measures included preoperative presentation, intraoperative findings, and subsequent intervention. Results Preoperative hearing loss and imbalance were seen in 70.5 and 64.7%, respectively. Suspicious intraoperative findings included: facial nerve incorporated intimately with the tumor capsule in 12 cases; spontaneous action potentials noted while drilling the bony IAC in 3 cases; and action potentials noted on stimulation of the entire tumor capsule in 10 cases. The mean long-term facial function was House–Brackmann grade II and the mean length of follow-up was 4.86 years. Conclusion FNSs are rare and may be difficult to distinguish from VS preoperatively. Surgical findings that should raise concern include spontaneous action potentials during drilling the bony IAC, absence of a plane of dissection between the facial nerve and tumor, or stimulation of the tumor capsule.

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