Complications of Translabyrinthine Vs. Suboccipital Approach for Acoustic Tumor Surgery

This study presents the operative results of surgeons with experience in both the translabyrinthine and suboccipital approaches to acoustic tumor removal for the purpose of resolving some of the controversy among centers favoring one approach over the other. The subjects were 171 patients with acoustic tumors who were treated at Virginia Mason Clinic from 1975 to 1986. The translabyrinthine approach was used in 64% of cases, the suboccipital approach in 35%, and the middle fossa approach in 1%. There were minor differences in morbidity and mortality between approaches. These data did not favor one approach over another. In an exploratory analysis, we found that the morbidity with a planned two-stage translabyrinthine-suboccipital removal was greater than the morbidity with a one-stage removal.

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Middle Fossa Approach For Acoustic Tumor Removal

Otolaryngologic Clinics of North America ◽

10.1016/s0030-6665(20)30991-9 ◽

1992 ◽

Vol 25 (2) ◽

pp. 347-359 ◽

Cited By ~ 2

Author(s):

William F. House ◽

Clough Shelton

Keyword(s):

Middle Fossa ◽

Tumor Removal ◽

Middle Fossa Approach ◽

Acoustic Tumor

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Middle Fossa Approach for Acoustic Tumor Removal

Neurosurgery Clinics of North America ◽

10.1016/j.nec.2008.02.009 ◽

2008 ◽

Vol 19 (2) ◽

pp. 279-288 ◽

Cited By ~ 6

Author(s):

William F. House ◽

Clough Shelton

Keyword(s):

Middle Fossa ◽

Tumor Removal ◽

Middle Fossa Approach ◽

Acoustic Tumor

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Auditory-Nerve Integrity after Middle-Fossa Acoustic-Tumor Removal

Otolaryngology ◽

10.1016/s0194-5998(98)70016-6 ◽

1998 ◽

Vol 119 (6) ◽

pp. 588-592 ◽

Cited By ~ 6

Author(s):

Rick A. Friedman ◽

Derald E. Brackmann ◽

Dawna Mills

Keyword(s):

Auditory Nerve ◽

Middle Fossa ◽

Tumor Removal ◽

Acoustic Tumor

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Middle Fossa Approach for Facial Nerve Schwannoma Aiming for Functional Improvement: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz178 ◽

2019 ◽

Vol 18 (5) ◽

pp. E167-E168

Author(s):

Ken Matsushima ◽

Michihiro Kohno ◽

Hitoshi Izawa ◽

Yujiro Tanaka

Keyword(s):

Facial Nerve ◽

Facial Palsy ◽

Tumor Resection ◽

Nerve Fibers ◽

Middle Fossa ◽

Tumor Removal ◽

Middle Fossa Approach ◽

Brainstem Response ◽

Facial Nerve Schwannoma

Abstract The treatment paradigm of skull base surgery has been changed from radical tumor resection to maximal tumor removal while giving priority to functional preservation. Facial nerve schwannoma is one of the representative disorders of this type of paradigm shift.1 This video demonstrates facial nerve schwannoma surgery through the middle fossa approach, aiming for improvement of facial function. A 33-yr-old woman presented with gradually worsening facial palsy (House-Brackmann grade IV), dizziness, and nausea. Neuroimaging revealed a growing tumor involving the geniculate ganglion, and extending to the middle fossa, internal acoustic meatus, and cerebellopontine angle. The nerve-sparing surgery through the left middle fossa approach was performed under detailed neuromonitoring including the evoked facial electromyograms and auditory brainstem response. The facial nerve fibers were involved within the tumor mass and the plane between the tumor and facial nerve could not be identified as seen in most cases of such large facial nerve schwannomas. But sufficient tumor removal with facial nerve preservation was achieved owing to continuous facial monitoring.2 The patient had no new neurological deficits. Her facial palsy has been gradually improving, now at grade III, without any signs of tumor regrowth during the 10 mo of follow up after the operation. Careful follow up is being continued to survey the possible tumor recurrence. The video was reproduced after informed consent of the patient.

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Surgery for Acoustic Neurinomas: A Proposal

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894840930s411 ◽

1984 ◽

Vol 93 (4_suppl) ◽

pp. 59-62

Author(s):

William W. Montgomery

Keyword(s):

Hearing Loss ◽

Adipose Tissue ◽

Posterior Fossa ◽

Vestibular Schwannomas ◽

Middle Fossa ◽

Internal Auditory Meatus ◽

Tumor Removal ◽

Acoustic Neurinomas ◽

Improved Technique ◽

Suboccipital Approach

Surgery for resection of acoustic neurinomas (vestibular schwannomas) has been performed by way of the middle fossa craniotomy, suboccipital route, and translabyrinthine operation. The author has preferred the translabyrinthine operation for small tumors (less than 2 cm) for patients with poor hearing and the suboccipital approach for large tumors and for small tumors when attempting to preserve hearing. This paper proposes an operation designed for better tumor removal results, an improved technique for preservation of hearing, and fewer complications. During the first part of the operation, the posterior fossa dura posterior to the labyrinth, and also bound by the superior petrosal and sigmoid venous sinuses, is exposed by the mastoidectomy route. The mastoid is obliterated with adipose tissue. The suboccipital route is then used to resect large tumors and small tumors when attempting to preserve hearing. This operation would 1) facilitate dissection of the internal auditory meatus, 2) reduce chance for injury to the labyrinth with a resulting total hearing loss, and 3) eliminate the rather frequent (less than 10%) incidence of postoperative CSF otorhinorrhea and its complications.

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Endoscope-Assisted Retrosigmoid Intradural Suprameatal Approach for Surgical Treatment of Trigeminal Schwannomas

Operative Neurosurgery ◽

10.1227/neu.0000000000000478 ◽

2014 ◽

Vol 10 (4) ◽

pp. 565-575 ◽

Cited By ~ 10

Author(s):

Madjid Samii ◽

Maysam Alimohamadi ◽

Venelin Gerganov

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

The Other ◽

Gross Total Resection ◽

Petrous Apex ◽

Middle Fossa ◽

Tumor Removal ◽

Total Resection ◽

Radical Removal ◽

Tumor Remnant

AbstractBACKGROUND:Trigeminal schwannomas are the most common intracranial nonvestibular schwannomas, and the dumbbell-shaped subtype is the most challenging.OBJECTIVE:To evaluate the efficiency and safety of the endoscope-assisted retrosigmoid intradural suprameatal approach (EA-RISA) for dumbbell trigeminal schwannomas and to compare EA-RISA with classic RISA.METHODS:A retrospective study of all patients with trigeminal schwannomas was performed with a focus on dumbbell tumors. Tumors were classified according to a modified Samii classification. Extent of tumor removal, outcome, and morbidity rates in the 2 subgroups were compared.RESULTS:Twenty patients were enrolled: 8 had dumbbell-shaped tumors (type C1), 8 had middle fossa tumors (A1-3), 3 had extracranial extension (D2), and 1 had posterior fossa tumor. Gross total resection was achieved in 15 and near-total resection in 5 patients. In 4 patients with dumbbell tumors, the classic RISA (Samii approach) was used; EA-RISA was used in the other 4 patients. The extent of petrous apex drilling was determined individually on the basis of the anatomic variability of suprameatal tubercle and degree of tumor-induced petrous apex erosion; in 2 patients, only minimal drilling was needed. The endoscope was applied after microsurgical tumor removal and in 3 of 4 patients revealed a significant unrecognized tumor remnant in the anterolateral and superolateral aspects of the Meckel cave. Thus, the EA-RISA technique allowed gross total resection of the tumor.CONCLUSION:The EA-RISA enlarges the exposure obtained with the classic RISA. Its judicious use can help achieve safe and radical removal of dumbbell-shaped trigeminal schwannomas (C1 type).

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Management of Cerebrospinal Fluid Leaks After Acoustic Tumor Removal

Operative Neurosurgery ◽

10.1227/01.neu.0000289709.87802.12 ◽

2007 ◽

Vol 61 (suppl_3) ◽

pp. ONS-35-ONS-40 ◽

Cited By ~ 8

Author(s):

Rick A. Friedman ◽

Robert D. Cullen ◽

Jeffrey Ulis ◽

Derald E. Brackmann

Keyword(s):

Cerebrospinal Fluid ◽

Eustachian Tube ◽

Csf Leak ◽

Surgical Removal ◽

Middle Fossa ◽

Tumor Removal ◽

Csf Rhinorrhea ◽

Lumbar Drain ◽

Hearing Status ◽

Acoustic Tumor

Abstract Objective: To present a logical algorithm for management of postoperative cerebrospinal fluid (CSF) leak that occurs after acoustic tumor removal, and to describe a method for eustachian tube resection. Clinical Presentation: We present an algorithm in the form of a flow chart, describe middle fossa craniotomy for eustachian tube resection, and present three cases in which this technique was used. Technique: For CSF leak, pressure dressing at the wound and bed rest for the patient are advised; lumbar drain is indicated if the leak does not resolve. Occasionally, wound exploration is required. CSF rhinorrhea is treated first with a lumbar drain. If this approach is unsuccessful, the choice of treatment depends on the patient's hearing status. If a patient has no hearing, we perform a blind sac closure of the ear canal and pack the eustachian tube. If a patient has hearing, wound reexploration and lumbar drainage are advised. When conservative and initial surgical procedures for resolving CSF leak fail, we perform a middle fossa craniotomy to identify, divide, and remove a segmental portion of the cartilaginous eustachian tube and then cauterize and occlude both ends. Conclusion: At centers where surgical removal of acoustic tumors is frequently performed, a logical protocol should be in place for treatment of postoperative CSF leak. The leak location and the patient's hearing status are factors in determining the appropriate treatment method. Middle fossa craniotomy for resection of the eustachian tube is a safe, definitive management option for treatment of recalcitrant CSF rhinorrhea that occurs after acoustic tumor surgery.

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