scholarly journals Transcanal Microscopic Transpromontorial Approach for Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S279-S280 ◽  
Author(s):  
Brandon Isaacson ◽  
Anthony M. Tolisano ◽  
Ankur Ramanlal Patel ◽  
Samuel L. Barnett
Keyword(s):  
Minimally Invasive ◽  
Vestibular Schwannoma ◽  
Skull Base Surgery ◽  
Tertiary Care ◽  
Internal Auditory Canal ◽  
Surgical Anatomy ◽  
Surgical Indications ◽  
Invasive Approach ◽  
Microsurgical Resection ◽  
Reconstructive Techniques

Objectives This video demonstrates the transcanal transpromontorial approach for resection of vestibular schwannoma. Design/Setting/Participants Present study is based on a video of a single patient undergoing the above approach at a tertiary care skull base surgery program. Results This video demonstrates a transcanal microscopic transpromontorial approach for resection of an enlarging intracanalicular vestibular schwannoma in a young patient with nonserviceable hearing. The video highlights the pertinent surgical anatomy and outlines, in a step-by-step fashion, the approach to the internal auditory canal via this minimally invasive approach. The surgical indications and reconstructive techniques are also discussed (Fig. 1). Conclusions A transcanal microscopic transpromontorial approach for vestibular schwannoma is feasible and offers a minimally invasive option for patients electing for microsurgical resection.The link to the video can be found at: https://youtu.be/-oKkRooytws.

scholarly journals Retrosigmoid Craniectomy for Vestibular Schwannoma with Hearing Preservation

2018 ◽  
Vol 80 (S 03) ◽  
pp. S274-S275
Author(s):  
Anthony M. Tolisano ◽  
Ankur R. Patel ◽  
Samuel L. Barnett ◽  
Brandon Isaacson
Keyword(s):  
Skull Base ◽  
Vestibular Schwannoma ◽  
Skull Base Surgery ◽  
Tertiary Care ◽  
Hearing Preservation ◽  
Normal Hearing ◽  
Surgical Anatomy ◽  
Gross Total Resection ◽  
Single Patient ◽  
Total Resection

Objectives To describe a retrosigmoid craniectomy, hearing-preservation approach for resection of vestibular schwannoma. Design/Setting/Participants A video of a single patient undergoing the above approach at a tertiary care skull base surgery program. Results This video demonstrates a retrosigmoid craniectomy approach for resection of an enlarging intracanalicular vestibular schwannoma in a patient with normal hearing. The video highlights the pertinent surgical anatomy and outlines in a step-by-step fashion the surgical steps. The patient obtained a gross total resection with preservation of hearing. Conclusion A retrosigmoid craniectomy approach for vestibular schwannoma offers a potentially hearing preservation approach for selected tumors.The link to the video can be found at: https://youtu.be/VM663XztRZw.

scholarly journals Endoscopic-assisted microsurgical resection of giant vestibular schwannoma in semi-sitting position

2021 ◽  
Vol 5 (2) ◽  
pp. V3
Author(s):  
Gang Song ◽  
Liyong Sun ◽  
Yuhai Bao ◽  
Jiantao Liang
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Residual Tumor ◽  
Nerve Function ◽  
Tumor Removal ◽  
Function Preservation ◽  
Microsurgical Resection ◽  
Dissection Technique ◽  
Total Tumor Removal ◽  
Facial Function

The main objectives of microsurgery for vestibular schwannoma are total tumor removal and preservation of facial and cochlear nerve function. For giant tumors, total tumor removal and facial nerve function preservation are challenging. The semisitting position has some advantages. In this video the authors show the removal of a giant vestibular schwannoma with the patient in a semisitting position. They demonstrate the advantages of the semisitting technique, such as the two-handed microsurgical dissection technique and a clear operative field. Finally, a small residual tumor in the internal auditory canal was removed by endoscopy. The patient’s facial function was House-Brackmann grade I at discharge. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2176

scholarly journals Surgical anatomy of the supracarinal esophagus based on a minimally invasive approach: vascular and nervous anatomy and technical steps to resection and lymphadenectomy

2016 ◽  
Vol 31 (4) ◽  
pp. 1863-1870 ◽  
Author(s):  
Miguel A. Cuesta ◽  
Nicole van der Wielen ◽  
Teus J. Weijs ◽  
Ronald L. A. W. Bleys ◽  
Suzanne S. Gisbertz ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Anatomy ◽  
Minimally Invasive Approach ◽  
Invasive Approach

scholarly journals Surgical anatomy of the omental bursa and the stomach based on a minimally invasive approach: different approaches and technical steps to resection and lymphadenectomy

2017 ◽  
Vol 9 (S8) ◽  
pp. S809-S816 ◽  
Author(s):  
Hylke J. F. Brenkman ◽  
Nicole I. van der Wielen ◽  
Jelle P. Ruurda ◽  
Maarten S. van Leeuwen ◽  
Joris J. G. Scheepers ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Anatomy ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Omental Bursa

PS02.011: ESOPHAGECTOMY IN A LOW VOLUME SINGLE CENTER FAVORING A TOTAL MINIMALLY INVASIVE APPROACH: 55 PATIENTS IN 7 YEAR

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 123-123
Author(s):  
Philipp Gehwolf ◽  
Thomas Schmid ◽  
Dietmar Öfner-Velano ◽  
Heinz Wykypiel
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Esophageal Resection ◽  
Thoracic Esophagus ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Low Volume

Abstract Background In Austria esophageal cancer is not very common. The incidence is 8.8/100.000 per year, thus esophageal cancer is on rank 18 of the most common carcinomas. Multimodal treatment inclouding surgery is standard for locally advanced esophageal cancer with a 5-year survival rate of around 40% in patients treated with a curative intent. Methods Retrospective single institution study in a tertiary care center using prospectively collected data we discuss our surgical procedure with patient survival as primary endpoint and morbidity as secondary endpoint. Results From 2010–1017, 55 Patients received an esophageal resection. The mean age was 61.5 years, five patients (9%) were female. Squamous cell carcinoma appeared in 37%, adenocarcinoma in 59% and a verrucous carcinoma in 4% of our patients. 98% of patients received an esophagectomy with gastric tube pull up, in 2% the colon was used for reconstruction. For patients with carcinoma located in the lower and middle thoracic esophagus a thoracic anastomosis was targeted (78%), in carcinomas of the upper thoracic esophagus a left cervical anastomosis (22%) was performed. Depending on location and comorbidities patients received either a conventional operation (11%), a hybrid operation with laparotomy and thoracoscopic esophageal resection (59%) or a totally minimal invasive approach (30%). The 60 days mortality was < 2%, the need for reoperation < 10%. Major complications (Clavien-Dindo III-V) were observed in 30%. Conclusion Esophagectomy is a high-risk operation with serious mortality and morbidity. However, patients may profit from a tailored approach with intent for the minimally invasive approach even in a low volume center when expertise in high-end endoscopic surgery is available. Disclosure All authors have declared no conflicts of interest.

“Save the Nerve”: Technical Nuances for Hearing Preservation and Restoration in Vestibular Schwannoma Surgery: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Rami O Almefty ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Hearing Loss ◽  
Cochlear Implants ◽  
Surgical Resection ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Severe Hearing Loss ◽  
Significant Disability ◽  
Microsurgical Resection

Abstract Hearing loss is a significant disability that inflects dysfunction and affects the patient quality of life. Consequently, hearing preservation and the potential of hearing restoration are prized quests in the management of vestibular schwannoma.1 Although small intracanalicular vestibular schwannomas are commonly observed, progressive hearing loss occurs despite the absence of tumor growth; hence, surgical resection can be performed with the sole aim of hearing preservation in well-informed and eager patients. Hearing preservation by surgical resection has proven to be durable.1-4 In this group of patients, we concur with Yamakami et al2 that vascularized meatal flap to reconstruct the canal helps prevent scarring of the cochlear nerve and provides cerebrospinal fluid (CSF) bathing to the cochlear nerve, yielding better long-term hearing preservation.  With larger tumors and more severe hearing loss at presentation, microsurgical resection should aim at preserving the cochlear nerve, a goal frequently achievable, which offers the potential for hearing restoration with cochlear implants.3 The results of cochlear implants in restoration of severe hearing loss have been to say the least most impressive.5 We demonstrate these 2 frequently encountered clinical situations with 2 surgical videos showing specific surgical tenets, including intra-arachnoidal dissection, medial to lateral manipulation of the tumor, preservation of the labyrinthine artery, as well as reconstruction of the internal auditory canal.2,3,6,7 The patients consented to the surgery and to the publication of their picture in a surgical video.  Illustration in video © 1997 O. Al-Mefty. Used with permission. All rights reserved.

Navigated Minimally Invasive Presigmoidal Suprabulbar Infralabyrinthine Approach to the Jugular Foramen Without Rerouting of the Facial Nerve

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. ons3-ons15 ◽  
Author(s):  
Zafer Cinibulak ◽  
Joachim K. Krauss ◽  
Makoto Nakamura
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
High Speed ◽  
Jugular Foramen ◽  
Surgical Anatomy ◽  
Sigmoid Sinus ◽  
Surgical Approaches ◽  
High Resolution Computed Tomography ◽  
Invasive Approach ◽  
Fallopian Canal

Abstract BACKGROUND: Jugular foramen tumors are rare and challenging lesions for skull base surgeons because of their difficult operative accessibility. Various surgical approaches to the jugular foramen have been described to overcome the morbidity of standard petrosectomy. OBJECTIVE: To describe the surgical anatomy of a novel route to the jugular foramen without opening the fallopian canal, the navigated tailored presigmoidal suprabulbar infralabyrinthine approach. METHODS: Ten cadaver heads were dissected under navigational guidance on both sides to examine the advantages and limitations of the presigmoidal suprabulbar infralabyrinthine approach without opening the fallopian canal. Mastoidectomy was performed by using a high-speed drill. Under navigation guidance, the sigmoid sinus, jugular bulb, posterior semicircular canal, and fallopian canal were located and preserved. The jugular foramen with the extradural part of the IXth, Xth, and XIth nerve were identified. RESULTS: Measurements of the surgical corridor and exposed petrous bone area on high-resolution computed tomography showed that the navigated presigmoidal suprabulbar infralabyrinthine approach without opening the fallopian canal is a suitable route for extradural jugular foramen lesions with limited extension (approach height 5.59 ± 0.16 mm; approach width 7.68 ± 0.18 mm; approach surface 33.73 ± 1.37 mm2; approach depth 32.92 ± 0.21 mm; vertical angle α of the surgical approach 41.3° ± 0.9°; horizontal angle β of the surgical approach 40.5° ± 0.6°). CONCLUSION: The navigation-guided presigmoidal suprabulbar infralabyrinthine approach is a minimally invasive approach for selected lesions of the jugular foramen with preservation of the fallopian canal, labyrinthine block, and sigmoid sinus. This approach is suited for C1, De1, De2, Di1, and Di2 tumors according to the Fisch classification.

scholarly journals Access to the crista galli and the foramen caecum in nasal dermal sinus cysts - lessons learned in a single tertiary care centre

2013 ◽  
Vol 51 (1) ◽  
pp. 47-53
Author(s):  
D. Vital ◽  
N. Krayenbuhl ◽  
O. Bozinov ◽  
D. Holzmann
Keyword(s):  
Minimally Invasive ◽  
Tertiary Care ◽  
Nasal Bone ◽  
Surgical Techniques ◽  
Lessons Learned ◽  
Invasive Technique ◽  
Dermal Sinus ◽  
Open Rhinoplasty ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Objective: Several surgical techniques have been suggested for the treatment of nasal dermal sinus cysts (NDSC). We have used several different techniques and have developed a minimally invasive approach. The aim of this study is to describe the evolution to this approach and compare the results with those achieved with our experience of more traditional techniques. Methodology/principal: A retrospective data collection of patients with NDSC presenting to our clinic between 1998 and 2012 was performed. We initially performed external approaches as outlined elsewhere. With an increasing number of young children requiring surgery, the technique was modified to a less invasive form. This new approach starts with mobilisation of the pit via a tiny skin incision. An open rhinoplasty approach is used to follow the fistula on the nasal bone. Once the fistula passes underneath the nasal bone, an endoscopic endonasal approach is used. Following the fistula cranially, the area of the foramen caecum can be identified. Results: Twelve out of 15 patients (80%) were treated surgically. The transfacial, coronal subcranial and minimally invasive approach was used in 3 (25%), 4 (33%) and 5 patients (42%), respectively. Radical resection was achieved in all patients. Cosmetic problems were present in all patients undergoing a transfacial and in half of the patients after the coronal subcranial approach. Patients treated by the minimally invasive technique remained without sequelae. Conclusion: The minimally invasive approach enables a perfect exposure of the fistula up to the crista galli and provides less morbidity and better cosmetic results than the transfacial and subcranial approach.

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