scholarly journals Internal Auditory Canal Reconstruction After Vestibular Schwannomas Removal Through Retrosigmoid-Transmeatal Approach

2018 ◽  
Vol 26 (3) ◽  
pp. 237-241
Author(s):  
Ricardo Ramina ◽  
Gustavo Simiano Jung ◽  
Erasmo Barros Da Silva Jr ◽  
Guilherme José Agnoletto ◽  
Luis Fernando Moura Da Silva Jr ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Jugular Foramen ◽  
Vestibular Schwannomas ◽  
Fat Tissue ◽  
Resonance Imaging ◽  
Tumor Removal ◽  
Postoperative Mri ◽  
Csf Leakage ◽  
Magnetic Resonance Imaging Mri

Objectives: To present a technique of internal auditory canal (IAC) reconstruction using a pediculated dural flap, after removal of vestibular schwannomas through the retrosigmoid craniotomy. Methods: From a series of 213 patients with vestibular schwannomas operated between January 2008 and March 2016 through the retrosigmoid-transmeatal approach, 183 underwent reconstruction of the internal auditory canal with a pediculated dural flap. The IAC was drilled towards the fundus preserving the labyrinthine structures. The dura mater over the IAC was dissected from the bone, remaining pediculated at the entrance of the jugular foramen. This dural flap was used to cover the cranial nerves inside the IAC after tumor removal. Opened mastoid cells and the IAC were closed with muscle or fat grafts and fibrin glue. Results: Reconstruction of the IAC using the described technique was possible in in 183 cases. Fifteen patients (6.8%) developed postoperative cerebrospinal fluid (CSF) leakage and seven patients required reoperation (3.2%) to close the fistulae. Postoperative magnetic resonance imaging (MRI) examinations showed the presence of CSF within the IAC around the preserved cranial nerves. Conclusions: This technique of IAC reconstruction after surgical resection of vestibular schwannomas may avoid scar and adhesion of muscle or fat tissue with preserved cranial nerves, allowing CSF enter inside the IAC. It may help to identify tumor remnants and/or recurrences in postoperative MRI examinations. Comparative studies are needed to evaluate if this technique improves postoperative hearing and facial nerve outcomes.

Hamartomas of the Internal Auditory Canal: Report of Two Cases

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 944-949 ◽  
Author(s):  
Gustavo A. Carvalho ◽  
Cordula Matthies ◽  
Enrique Osorio ◽  
Madjid Samii
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Auditory Brainstem ◽  
Tumor Infiltration ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Tumor Removal

Abstract OBJECTIVE AND IMPORTANCE To highlight the clinical, radiological, and surgical findings and therapeutic options for this rare entity, which may mimic a purely intrameatal vestibular schwannoma, and to define the particular aspects of preoperative differential diagnosis and surgical management. CLINICAL PRESENTATION Two patients presented with clinical findings typical of vestibular schwannomas, i.e., tinnitus, hearing loss of 30 dB, and an intrameatal contrast-enhancing lesion on magnetic resonance imaging studies. TECHNIQUE The lesions were exposed via a suboccipital transmeatal approach, and tumor infiltration of the cochlear and/or facial cranial nerves was identified. In view of the unclear intraoperative histology, surgical management was based on criteria of cranial nerve function. In Patient 1, after nerve decompression by subtotal tumor removal, preserved auditory brainstem responses and facial nerve electromyography indicated functional nerve preservation and facilitated the decision for partial resection. In Patient 2, minimal tumor dissection resulted in complete loss of auditory brainstem response without reversibility. Therefore, a radical tumor removal was performed that sacrificed the cochlear but preserved the facial nerve. CONCLUSION Symptoms and signs of internal auditory canal hamartomas are congruent with other typical pathological lesions of the internal auditory canal and cerebellopontine angle. Accurate preoperative diagnosis by radiological means is not possible, but careful evaluation of the different signal intensities on magnetic resonance imaging studies may indicate this rare pathological condition. Intraoperative surgical findings of tumor infiltration of the faciocochlear cranial nerve complex may support simple observation. In view of the nonneoplastic characteristic of these lesions, a more conservative approach is justified. The decision should be based on the functional status of the cranial nerves, for which reliable electrophysiological monitoring is indispensable.

Jugular foramen involvement in nasopharyngeal carcinoma

1996 ◽  
Vol 110 (10) ◽  
pp. 987-990 ◽  
Author(s):  
V. F. H. Chong ◽  
Y. F. Fan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Nasopharyngeal Carcinoma ◽  
Jugular Vein ◽  
Cranial Nerves ◽  
Jugular Foramen ◽  
Radiotherapy Planning ◽  
Denervation Atrophy ◽  
Resonance Imaging ◽  
Cranial Nerve Palsies ◽  
Magnetic Resonance Imaging Mri

AbstractNasopharyngeal carcinoma (NPC) may spread posterolaterally with infiltration of the jugular foramen, jugular vein and the cranial nerves IX-XI. Cranial nerve palsies may be evident clinically but the extent of skull base infiltration is best assessed radiologically. Denervation atrophy is well demonstrated by both magnetic resonance imaging (MRI) and computed tomography (CT). Accurate delineation of the lesion is important in prognosis and radiotherapy planning.

scholarly journals Retrosigmoid Transmeatal Approach with 360-Degree Drilling of the Internal Auditory Canal for the Resection of Intracanalicular Meningioma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S311-S311 ◽  
Author(s):  
Ricardo Ramina ◽  
Felipe Constanzo ◽  
Erasmo Barros da Silva ◽  
Maurício Coelho Neto
Keyword(s):  
Internal Auditory Canal ◽  
Anterior Wall ◽  
Vestibular Schwannomas ◽  
Auditory Function ◽  
Resonance Imaging ◽  
Total Resection ◽  
Cavernous Malformations ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Grade Iii

Introduction Vestibular schwannomas are the most common lesions occupying the internal auditory canal (IAC); however, almost in 4 to 5% of meningiomas, metastases, cysts, lipomas, and cavernous malformations have been found in this location, mimicking schwannomas. Even though cerebellopontine angle (CPA) meningiomas with the involvement of the IAC are frequently encountered, the presence of a primary intracanalicular meningioma is rare. Objective To show the technical nuances of the retrosigmoid-transmeatal approach to successfully achieve gross total resection (GTR) with preservation of facial and auditory function. Case Report We present a left intracanalicular meningioma on a 60-year-old man with history of tinnitus and hearing loss. Magnetic resonance imaging (MRI) showed a left intracanalicular lesion completely obliterating the IAC and with minor extension to the CPA cistern, with the vestibulocochlear complex dislocated posteriorly, initially diagnosed as a Hannover's T2 vestibular schwannoma. The patient underwent a left retrosigmoid approach, and during the exposure of the lesion, the diagnosis of a meningioma became evident. The transmeatal phase of the approach was modified with a wide opening of the canal, including the anterior wall. Closure was performed using a muscle graft, duramater flap, and fibrin glue. Results GTR was achieved and the patient developed a mild facial palsy (House–Brackmann grade III) which completely recovered within 3 months. Conclusions The retrosigmoid transmeatal approach is suitable to achieve GTR in intracanalicular meningiomas. Some modifications of the approach intended for vestibular schwannomas are necessary and may be performed during the procedure.The link to the video can be found at: https://youtu.be/A9OXRFIl1e8.

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 Preoperative measurements on MRI in Chiari 1 patients fail to predict outcome after decompressive surgery

2021 ◽  
Author(s):  
Miro-Pekka Jussila ◽  
Juho Nissilä ◽  
Minna Vakkuri ◽  
Päivi Olsén ◽  
Jaakko Niinimäki ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
University Hospital ◽  
Resonance Imaging ◽  
Surgical Decision ◽  
Postoperative Mri ◽  
Before And After ◽  
Magnetic Resonance Imaging Mri ◽  
Surgical Decision Making ◽  
Mri Evaluation ◽  
Outcome Of Surgery

Abstract Background The purpose of our study was to research the parameters of magnetic resonance imaging (MRI) that would predict the outcome of surgery in patients with Chiari 1 malformation (CM1) and to evaluate changes in MRI parameters after surgery. Methods Fifty-one patients (19 children, 13 adolescents, and 19 adults) operated on due to CM1 in Oulu University Hospital between 2004 and 2018 were evaluated. Seventeen parameters were measured from the preoperative MRI and 11 from the postoperative MRI. The correlations between the MRI parameters and the clinical variables before and after surgery were analyzed. Results The majority (88.2%) of the patients had favorable surgical outcomes. Postoperatively, subjective symptoms improved in 88.6% of the patients and syringomyelia in 81.8%. The location of the cerebellar tonsils, when measured in relation to the C2 synchondrosis or the end plate, postoperatively moved cranially in 51.0% (n = 26), did not change in 27.4% (n = 14), and moved caudally in 21.6% (n = 11) of the patients. However, neither the location of the tonsils nor any other parameters measured from pre- or postoperative MRI correlated with the patients’ symptoms or surgical outcomes. Conclusions No specific parameters on preoperative MRI evaluation were predictive of the outcome of surgery, emphasizing clinical examination in surgical decision-making. Furthermore, the postoperative MRI parameters did not correlate with the surgical outcomes. Thus, routine postoperative imaging is suggested only for patients with preoperatively diagnosed syringomyelia or worsening of symptoms.

scholarly journals Transarterial Onyx embolization of jugular foramen dural arteriovenous fistula with spinal venous drainage manifesting as myelopathy—a case report and review of the literature

2016 ◽  
Vol 22 (5) ◽  
pp. 579-583 ◽  
Author(s):  
Hengwei Jin ◽  
Xianli Lv ◽  
Youxiang Li
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Brain Mri ◽  
Venous Drainage ◽  
Jugular Foramen ◽  
Endovascular Embolization ◽  
High Signal ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Progressive Weakness

We report a rare case of jugular foramen dural arteriovenous fistula (DAVF) with spinal venous drainage. A 48-year-old woman suffered from progressive weakness of lower extremities and incontinence of urine and feces for 14 days. Magnetic resonance imaging (MRI) revealed a tortuous posterior medullary vein at C2–T2 and ischemic signal at C2–C4 of the spinal cord. Brain MRI revealed an abnormal high signal near the left jugular foramen. Digital subtraction angiography of the spinal vascular was negative, while brain angiography showed a left jugular foramen DAVF with spinal perimedullary venous drainage. The patient recovered completely soon after endovascular embolization with Onyx-18. Diagnosis of a DAVF presenting with myelopathy is challenging. Early diagnosis and treatment are essential for a favorable outcome.

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 Surgical treatment of glossopharyngeal nerve schwannomas: Results of two-center study (14 patients included) and literature review

2021 ◽  
Vol 27 (4) ◽  
pp. 23-29
Author(s):  
Andrii H. Sirko ◽  
Oleksandr M. Lisianyi ◽  
Оksana Y. Skobska ◽  
Rostislav R. Malyi ◽  
Iryna O. Popovych ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Facial Nerve ◽  
Hearing Impairment ◽  
Cranial Nerves ◽  
Type A ◽  
Jugular Foramen ◽  
Type B ◽  
Tumor Removal ◽  
Type D ◽  
Total Tumor Removal

Objective: This study is aimed to analyze the outcomes of surgical treatment of glossopharyngeal schwannomas based on pre- and postoperative neurological status assessment. Materials and methods: This paper is a retrospective analysis of examination and surgical treatment of 14 patients who were operated on in two large clinics from 2018 to 2021 inclusive. When analyzing the collected data, gender, age, disease symptoms, tumor size and location, surgical approach, tumor to cranial nerves (CN) ratio, jugular foramen (JF) condition, and tumor removal volume were taken into account. All tumors were divided into groups depending on tumor location relative to the JF. Particular attention was paid to assessing cranial nerves functions. Facial nerve function was assessed as per House-Brackmann Scale (HBS), hearing function as per Gardner-Robertson Scale (GRS). Results: 3 (21.4%) patients had total tumor removal: 2 patients had type A tumors and one had type B tumor. Subtotal resection took place in 7 (50%) cases. In 4 cases, a tumor was partially removed: 3 patients had type D tumors and one had type B tumor. 3 (21.4%) patients had preoperative FN deficit (HBS Grade II) and mild dysfunction. 5 (35.7%) patients had postoperative facial nerve deficit: HBS ІІ, 2; ІІІ, 1; V, 2. Preoperative sensorineural type hearing impairment on the affected side was diagnosed in 13 (92.6%) patients. Before surgery, 6 patients had non-serviceable hearing, which remained at the same level after surgery. None of the patients with grade I or II hearing before surgery had any hearing impairment postoperatively. In 2 (14.3%) cases, hearing improved from grade V to grade III after surgery. 6 (42.9%) patients developed new neurological deficit in the caudal group CN. Postoperative deficit of the caudal group CN occurred in type D tumors in 3 patients, type A tumors 2 patients, and type B tumors one patient. Conclusions: Applying a retrosigmoid approach only makes it possible to achieve total tumor removal in case of type A tumors. To remove other tumor types, it is necessary to select approaches that enable access to the jugular foramen and infratemporal fossa. Intraoperative neurophysiological monitoring is an extremely important tool in glossopharyngeal schwannoma surgery. The most common postoperative complication is a developed or increased deficit of the caudal CN group, which can lead to persistent impairments in the patients’ quality of life. Preservation of the CN VII and VIII function in most cases is a feasible task and shall be ensured as a standard for this pathology.

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