Microsurgical Resection of Vestibular Schwannomas, Presentation of Cases in 3D: 3-Dimensional Operative Video

2019 ◽  
Vol 19 (1) ◽  
pp. E61-E62
Author(s):  
Alvaro Campero ◽  
Matias Baldoncini
Keyword(s):  
Facial Nerve ◽  
Cochlear Nerve ◽  
Vestibular Schwannomas ◽  
Benign Tumors ◽  
3 Dimensional ◽  
Microsurgical Resection ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Functional Preservation

Abstract Vestibular schwannomas are the most common benign tumors of the pontocerebellar angle,1,2 their microsurgical complexity is related to their size and neurovascular relationships. The purpose of this work is to analyze the clinical, anatomic characteristics, microsurgical treatment, and the postoperative results according to the Hannover gradual scale in 4 patients with vestibular schwannomas. The 4 patients gave their consent to the procedure and all consented to the use of their surgical videos, preoperative and postoperative studies, and postoperative pictures. Case 1: A 39-yr-old woman, with left ear hearing loss. Magnetic resonance imaging (MRI) showed small Intracanalicular schwannoma (T1 classification by Hannover). Microsurgery was performed and resection through a retrosigmoid approach2,3 with anatomic and functional preservation of the facial and cochlear nerve. Case 2: A 40-yr-old woman, with left ear hypoacusia. MRI showed an extrameatal schwannoma reaching the brainstem (T3b Hannover classification). The complete re-section through retrosigmoid approach were performed. Case 3: A 69-yr-old woman, without hearing in the right ear. RM: Medium schwannoma (T4a classification of Hannover). Microsurgery was performed with anatomic and functional preservation of the facial nerve.4-6 Case 4: A 32-yr-old woman, without hearing in the left ear. In addition, cerebellar syndrome and headache. RM: Large schwannoma (T4b classification of Hannover). Sur-gery was performed, anatomic preservation of the facial nerve, with moderate paresis in the postoperative period. Microsurgical resection with functional preservation of the facial and cochlear nerve is the main objective7 when addressing this pathology.

scholarly journals Understanding the Radiobiology of Vestibular Schwannomas to Overcome Radiation Resistance

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4575
Author(s):  
Torin P. Thielhelm ◽  
Stefania Goncalves ◽  
Scott M. Welford ◽  
Eric A. Mellon ◽  
Erin R. Cohen ◽  
...  
Keyword(s):  
Cell Cycle ◽  
Current Knowledge ◽  
Vestibular Schwannomas ◽  
Benign Tumors ◽  
Intracranial Tumors ◽  
Treatment Protocols ◽  
Cycle Arrest ◽  
Microsurgical Resection ◽  
Cranial Nerve Viii ◽  
Key Events

Vestibular schwannomas (VS) are benign tumors arising from cranial nerve VIII that account for 8–10% of all intracranial tumors and are the most common tumors of the cerebellopontine angle. These tumors are typically managed with observation, radiation therapy, or microsurgical resection. Of the VS that are irradiated, there is a subset of tumors that are radioresistant and continue to grow; the mechanisms behind this phenomenon are not fully understood. In this review, the authors summarize how radiation causes cellular and DNA injury that can activate (1) checkpoints in the cell cycle to initiate cell cycle arrest and DNA repair and (2) key events that lead to cell death. In addition, we discuss the current knowledge of VS radiobiology and how it may contribute to clinical outcomes. A better understanding of VS radiobiology can help optimize existing treatment protocols and lead to new therapies to overcome radioresistance.

Microsurgical Resection of Trigeminal Schwannomas: 3-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E18-E18
Author(s):  
Duarte N C Cândido ◽  
Marcio S Rassi ◽  
Guilherme Henrique Weiler Ceccato ◽  
Jean Gonçalves de Oliveira ◽  
Luis A B Borba
Keyword(s):  
Trigeminal Nerve ◽  
Senior Author ◽  
Petrous Apex ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
3 Dimensional ◽  
History Of ◽  
Nerve Paresis ◽  
Microsurgical Resection ◽  
The Right

Abstract Trigeminal schwannomas are benign lesions arising from the Schwann cells of the trigeminal nerve. This is an unusual tumor that accounts for less than 0.4% of intracranial pathologies, even though they are the second most frequent schwannoma after the vestibular schwannoma. The tumor spreads along the natural course of the V nerve at its cisternal portion, along the ganglion inside Meckel's cave or through its peripheral division. Even though the tumor can reach great size and become multicompartmental. We present a 51-yr-old woman, with an history of 3 mo of incapacitating facial pain, that was found on examination to be on the territory of the third division of the trigeminal nerve on the right side. The MRI depicted a large homogeneous enhancing lesion at the base of the right middle fossa with extension through the petrous apex to the most superior and medial part of the posterior fossa. The patient was operated by the senior author, through a middle fossa approach, dissecting between the two layers of the middle fossa dura (the apparent inner and the true outer layer of the cavernous sinus), the so called middle fossa “peeling”. We achieved total resection of the tumor, but the patient presented after surgery with facial nerve paresis. This is thought to be related to geniculate ganglion manipulation, as it was unprotect by bone at the middle fossa and the patient maintained lacrimal function (post-geniculate alteration). It resolved completely after 6 mo. The patient consented to publication of her images.

The magnetless Clarion® cochlear implant in a patient with neurofibromatosis 2

1999 ◽  
Vol 113 (5) ◽  
pp. 458-463 ◽  
Author(s):  
J. Graham ◽  
C. Lynch ◽  
B. Weber ◽  
L. Stollwerck ◽  
J. Wei ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cochlear Implant ◽  
Cochlear Implants ◽  
Round Window ◽  
Cochlear Nerve ◽  
Resonance Imaging ◽  
Neurofibromatosis 2 ◽  
Hearing Thresholds ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

AbstractWe present our experience using the Clarion® magnetless multichannel cochlear implant with a woman profoundly deafened following bilateral acoustic neuromata as a consequence of neurofibromatosis 2 (NF2). The right neuroma had been previously removed without an attempt at neural preservation. On the left, however, a posterior fossa approach had been taken with the aim of preserving hearing. Although the left cochlear nerve appeared to be undamaged at the end of the operation, no hearing thresholds could be elicited on post-operative audiometry, because of damage either to the cochlear nerve or to the blood supply to the cochlea. Round window electrical stimulation subsequently produced a perception of sound, confirming that the cochlear nerve was capable of functioning and that a cochlear implant would be effective. Because she would need regular magnetic resonance imaging (MRI) to monitor existing and future NF2 lesions, it was decided to use a magnetless Clarion® implant, which has been shown to be MRI compatible. We report our experience of using the device in this case and discuss some of the issues related to the provision of cochlear implants to patients with NF2.

scholarly journals Intractable Trigeminal Neuralgia Secondary to Osteoma of the Clivus: A Case Report and Literature Review

2022 ◽  
Author(s):  
Ebtesam Abdulla ◽  
Krishna Das ◽  
Joseph Ravindra ◽  
Tejal Shah ◽  
Sara George
Keyword(s):  
Trigeminal Neuralgia ◽  
Pressure Effect ◽  
Benign Tumors ◽  
Radiographic Images ◽  
Patient Reported ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Slow Growing ◽  
Serial Observation

AbstractSkull base osteomas (SBOs) are benign tumors that are frequently detected on radiographic images by coincidence. They are known for being slow-growing tumors and rarely symptomatic. The therapeutic approach for SBOs can differ substantially. Depending on the symptoms, size, and location of the tumor, this can range from serial observation to vigorous surgical extirpation. Clival osteoma is extremely rare. We report a case of clival osteoma, causing intractable trigeminal neuralgia due to the pressure effect on the trigeminal nerve at Meckel's cave. We also provide a review of pertinent literature. A 37-year-old woman presented with intractable trigeminal neuralgia. Cranial magnetic resonance imaging (MRI) demonstrated a large, lobulated, extra-axial lesion involving the right cerebellopontine angle and epicentering the clivus. Pathologically, the specimen was proven to be osteoma. The patient reported complete symptom resolution over a 4-year follow-up period. To the best of the authors' knowledge, this is the first clinical case of intractable trigeminal neuralgia due to clival osteoma.

Complete Microsurgical Resection of Large Retrochiasmatic Hypothalamic Craniopharyngioma by Transpetrosal Approach: 2-Dimensional Operative Video

2019 ◽  
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Nina T Yoh ◽  
Laligam N Sekhar
Keyword(s):  
Frozen Section ◽  
Brain Magnetic Resonance Imaging ◽  
Optic Chiasm ◽  
Pituitary Stalk ◽  
Excessive Sleepiness ◽  
Microsurgical Resection ◽  
Magnetic Resonance Imaging Mri ◽  
Prefixed Chiasm ◽  
The Right ◽  
Retrochiasmatic Region

Abstract This two-dimensional video shows the technical nuances of complete microsurgical resection of a hypothalamic craniopharyngioma located in the retrochiasmatic region by the transpetrosal approach.  This 49-yr-old man presented with progressive fatigue, excessive sleepiness, and difficulty in vision in both eyes. He was found to have right CN 3 paralysis and bitemporal hemianopsia on neurological examination. Further workup revealed panhypopituitarism. Brain magnetic resonance imaging (MRI) demonstrated a large solid retrochiasmatic hypothalamic lesion with homogeneous contrast enhancement, measuring 2.1 × 2.6 × 2.4 cm. Optic chiasm was prefixed, and the tumor was just posterior to the pituitary stalk area. The preoperative differential diagnosis included hypothalamic astrocytoma, craniopharyngioma, germinoma, and histiocytosis. Because of the prefixed chiasm, a presigmoid, transpetrosal approach was performed. Our initial plan was a large biopsy, but based on frozen section histology, we decided to excise the tumor completely. The tumor had a pseudocapsule, which was firm and yellowish. It was debulked, dissected from the surrounding hypothalamus, and removed completely. The pituitary stalk was found at the anterior and inferior ends of the tumor and was preserved.  Postoperatively, the patient developed diabetes insipidus and requires desmopressin replacement, which was gradually tapered. For panhypopituitarism, he is receiving thyroxine, hydrocortisone, and testosterone.  Postoperatively, patient had an improvement in vision in his left eye and ptosis was improving in the right eye with mRs 1- at 10-wk follow-up.  An informed consent was obtained from the patient prior to the surgery, which included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Transient facial nerve palsy after topical papaverine application during vestibular schwannoma surgery

2007 ◽  
Vol 107 (5) ◽  
pp. 1039-1042 ◽  
Author(s):  
James K. Liu ◽  
Christina M. Sayama ◽  
Clough Shelton ◽  
Joel D. MacDonald
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Conduction Block ◽  
Auditory Brainstem ◽  
Cochlear Nerve ◽  
Auditory Brainstem Responses ◽  
Speech Discrimination ◽  
The Right

✓Some evidence in the literature supports the topical application of papaverine to the cochlear nerve to prevent internal auditory artery vasospasm and cochlear ischemia as a method of enhancing the ability to preserve hearing during acoustic neuroma surgery. The authors report a case of transient facial nerve palsy that occurred after papaverine was topically applied during a hearing preservation acoustic neuroma removal. A 58-year-old woman presented with tinnitus and serviceable sensorineural hearing loss in her right ear (speech reception threshold 15 dB, speech discrimination score 100%). Magnetic resonance imaging demonstrated a 1.5-cm acoustic neuroma in the right cerebellopontine angle (CPA). A retrosigmoid approach was performed to achieve gross-total resection of the tumor. During tumor removal, a solution of 3% papaverine soaked in a Gelfoam pledget was placed over the cochlear nerve. Shortly thereafter, the quality of the facial nerve stimulation deteriorated markedly. Electrical stimulation of the facial nerve did not elicit a response at the level of the brainstem but was observed to elicit a robust response more peripherally. There were no changes in auditory brainstem responses. Immediately after surgery, the patient had a House–Brackmann Grade V facial palsy on the right side. After several hours, this improved to a Grade I. At the 1-month follow-up examination, the patient exhibited normal facial nerve function and stable hearing. Intracisternal papaverine may cause a transient facial nerve palsy by producing a temporary conduction block of the facial nerve. This adverse effect should be recognized when topical papaverine is used during CPA surgery.

scholarly journals Facial Nerve Elongation in Vestibular Schwannomas: A Useful Aspect with Regard to Functional Preservation

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
Cordula Matthies ◽  
Nadine Lilla ◽  
Robert Nickl ◽  
Maria Hummel ◽  
Laszlo Solymosi ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Functional Preservation

scholarly journals Microsurgical Resection of Medulla Oblongata Hemangioblastoma: 2-Dimensional Operative Video

2018 ◽  
Vol 15 (5) ◽  
pp. E64-E65 ◽  
Author(s):  
Mirza Pojskić ◽  
Kenan I Arnautović
Keyword(s):  
Medulla Oblongata ◽  
Posterior Arch ◽  
Tumor Nodule ◽  
Posterior Aspect ◽  
Von Hippel Lindau ◽  
Postoperative Mri ◽  
Suboccipital Craniectomy ◽  
Microsurgical Resection ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Abstract This video demonstrates the microsurgical resection of brainstem hemangioblastoma. The patient is a 32-yr-old woman with Von Hippel Lindau syndrome who presented with quadriparesis and inability to swallow. Magnetic resonance imaging (MRI) of the neuroaxis revealed a brainstem cystic lesion with contrast-enhancing tumor nodule right along the posterior aspect of the lower part of medulla oblongata. The surgery was performed in the prone position with suboccipital craniectomy and partial C1 posterior arch removal. The aim of the surgery was to remove the tumor nodule.1-12 The tumor was separated from the right dorsal nerve roots, and then progressively dissected with coagulation of arterial feeders and draining vein and division of the pia circumferentially. Postoperative MRI revealed complete resection. The patient completely recovered from her quadriparesis and difficulty swallowing.

Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Matías Baldoncini ◽  
Alvaro Campero ◽  
Sabino Luzzi ◽  
Juan F Villalonga
Keyword(s):  
Right Hemisphere ◽  
Vascular Lesion ◽  
Neurological Deficits ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Drainage Vein ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Superior Longitudinal Sinus ◽  
The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4  The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5  This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes.  The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece.  The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM.  In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

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