Surgical approaches for resection of vestibular schwannomas: translabyrinthine, retrosigmoid, and middle fossa approaches

Surgical removal remains one of the key treatment modalities for vestibular schwannomas. A team approach between a neurotologist and a neurosurgeon offers the patient the expertise of both specialties and maximizes the chances for an optimal outcome. Vestibular schwannomas can typically be resected through 1 of 3 main surgical approaches: the translabyrinthine, the retrosigmoid, or the middle fossa approaches. In this report and videos, the authors describe and illustrate the indications and surgical techniques for the removal of these tumors.

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Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽

10.1024/1023-9332.9.2.55 ◽

2003 ◽

Vol 9 (2) ◽

pp. 55-62 ◽

Cited By ~ 7

Author(s):

Bartanusz ◽

Porchet

Keyword(s):

Spinal Cord ◽

Surgical Techniques ◽

Cord Compression ◽

Treatment Modalities ◽

Surgical Approaches ◽

Spinal Stabilization ◽

Management Algorithm ◽

Specific Manner ◽

Extensive Surgery ◽

Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

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Transzygomatic anterior infratemporal fossa approach and high cervical approach for resection of infra temporal fossa and parapharyngeal space solitary fibrous tumours

Romanian Neurosurgery ◽

10.33962/roneuro-2019-079 ◽

2019 ◽

pp. 492-497

Author(s):

Kazumi Ohmori ◽

Shiduka Kamiyoshi ◽

Taku Takeuchi ◽

Takanori Fukushima ◽

Takashi Tsuduki ◽

...

Keyword(s):

Parapharyngeal Space ◽

Infratemporal Fossa ◽

Cranial Nerves ◽

Surgical Approaches ◽

Surgical Removal ◽

Middle Fossa ◽

Temporal Fossa ◽

Solitary Fibrous Tumours ◽

The 1960S ◽

Superior Portion

The infratemporal fossa (ITF) is the region under the floor of the middle fossa giving passage to most major cerebral vessels and cranial nerves.(1) It is closely related to important adjacent regions such as the middle fossa, pterygopalatine fossa, orbit, and nasopharynx.(2) Due to the anatomical complexity in the ITF, surgical removal of the lesions in or around it is still challenging.(3) Since the 1960s, many surgeons have reported various surgical approaches. the preauricular transzygomatic approach via a transcranial route was reported to be used for exposure of the antero-superior portion of the ITF (2,3). Solitary fibrous tumours (SFTs) were first described by Klempere and Rabin in 1931 as spindle-cell tumours originating from the pleura.(4) With the exception of myopericytoma, infantile myofibromatosis and HPC-like lesions of the sinonasal tract showing myoid differentiation, all other HPC like lesions are best considered as subtypes of SFT.(5) Only a few cases of SFT have been described in the literature involving the skull base and parapharyngeal space.(6–8) The purpose of this article is to show anatomical dissections involving this surgical approach and to evaluate our surgical experience using it.

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New Trends and Developments in Patients with Severe Aortic Stenosis – Towards Optimal Treatment?

European Cardiology Review ◽

10.15420/ecr.2009.5.2.81 ◽

2009 ◽

Vol 5 (2) ◽

pp. 81 ◽

Cited By ~ 2

Author(s):

Martijn WA van Geldorp ◽

Johanna JM Takkenberg ◽

Ad JJC Bogers ◽

A Pieter Kappetein ◽

◽

...

Keyword(s):

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Surgical Techniques ◽

Treatment Strategies ◽

Tissue Doppler ◽

Doppler Imaging ◽

Treatment Modalities ◽

Diagnostic Tools ◽

Number Of Patients ◽

Transcatheter Valve

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.

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The history of neurosurgery at the House Clinic in Los Angeles

Journal of Neurosurgery ◽

10.3171/2019.5.jns19602 ◽

2020 ◽

Vol 133 (3) ◽

pp. 749-755 ◽

Cited By ~ 1

Author(s):

Gautam U. Mehta ◽

Gregory P. Lekovic

Keyword(s):

Los Angeles ◽

Vestibular Schwannoma ◽

Video Transmission ◽

Collaborative Work ◽

Hearing Preservation ◽

Auditory Brainstem ◽

Team Approach ◽

Middle Fossa ◽

History Of ◽

Operative Microscope

Although most widely known as the birthplace of neuro-otology, the House Clinic in Los Angeles has been the site of several major contributions to the field of neurosurgery. From the beginning of the formation of the Otologic Medical Group in 1958 (later renamed the House Ear Clinic), these contributions have been largely due to the innovative and collaborative work of neurosurgeon William E. Hitselberger, MD, and neuro-otologist William F. House, MD, DDS. Together they were responsible for the development and widespread adoption of the team approach to skull-base surgery. Specific neurosurgical advances accomplished at the House Clinic have included the first application of the operative microscope to neurosurgery, the application of middle fossa and translabyrinthine approaches for vestibular schwannoma, and the development of combined petrosal, retrolabyrinthine, and other alternative petrosal approaches and of hearing preservation surgery for vestibular schwannoma. The auditory brainstem implant, invented at the House Clinic in 1979, was the first ever successful application of central nervous system neuromodulation for restoration of function. Technological innovations at the House Clinic have also advanced neurosurgery. These include the first video transmission of microsurgery, the first suction irrigator, the first debulking instrument for tumors, and the House-Urban retractor for middle fossa surgery.

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Use of endoscopic transorbital and endonasal approaches for 360° circumferential access to orbital tumors

Journal of Neurosurgery ◽

10.3171/2020.6.jns20890 ◽

2020 ◽

pp. 1-10

Author(s):

Chiman Jeon ◽

Sang Duk Hong ◽

Kyung In Woo ◽

Ho Jun Seol ◽

Do-Hyun Nam ◽

...

Keyword(s):

Optic Nerve ◽

Minimally Invasive ◽

Surgical Techniques ◽

Cystic Teratoma ◽

Subtotal Resection ◽

Zone Model ◽

Team Approach ◽

Orbital Tumors ◽

Total Resection ◽

Endoscopic Transorbital

OBJECTIVEOrbital tumors are often surgically challenging because they require an extensive fronto-temporo-orbital zygomatic approach (FTOZ) and a multidisciplinary team approach to provide the best outcomes. Recently, minimally invasive endoscopic techniques via a transorbital superior eyelid approach (ETOA) or endoscopic endonasal approach (EEA) have been proposed as viable alternatives to transcranial approaches for orbital tumors. In this study, the authors investigated the feasibility of 360° circumferential access to orbital tumors via both ETOA and EEA.METHODSBetween April 2014 and June 2019, 16 patients with orbital tumors underwent either ETOA or EEA at the authors’ institution. Based on the neuro-topographic “four-zone model” of the orbit with its tumor epicenter around the optic nerve in the coronal plane, ETOA (n = 10, 62.5%) was performed for tumors located predominantly superolateral to the nerve and EEA (n = 6, 37.5%) for those located predominantly inferomedial to the nerve. Eight patients (50%) presented with intraconal tumors and 8 (50%) with extraconal ones. The orbital tumors included orbital schwannoma (n = 6), cavernous hemangioma (n = 2), olfactory groove meningioma (n = 1), sphenoorbital meningioma (n = 1), chondrosarcoma (n = 1), trigeminal schwannoma (n = 1), metastatic osteosarcoma (n = 1), mature cystic teratoma (n = 1), sebaceous carcinoma (n = 1), and ethmoid sinus osteoma (n = 1). The clinical outcomes and details of surgical techniques were reviewed.RESULTSGross-total resection was achieved in 12 patients (75%), near-total resection in 3 (18.8%), and subtotal resection in 1 (6.2%). Eight (88.9%) of the 9 patients with preoperative proptosis showed improvement after surgery, and 4 (66.7%) of the 6 patients with visual symptoms demonstrated improvement. Four (40%) of the 10 patients treated with ETOA experienced partial third nerve palsy immediately after surgery (3 transient and 1 persistent). There have been no postoperative CSF leaks or infections in this series.CONCLUSIONSWithout transcranial approaches requiring temporalis muscle dissection and orbitozygomatic osteotomy, the selection of ETOA or EEA based on a concept of a four-zone model with its epicenter around the optic nerve successfully provides a minimally invasive 360° circumferential access to the entire orbit with acceptable morbidity.

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Excision of Lower Lip Mucocele Using Injection of Hydrocolloid Dental Impression Material in a Pediatric Patient: A Case Report

Applied Sciences ◽

10.3390/app11135819 ◽

2021 ◽

Vol 11 (13) ◽

pp. 5819

Author(s):

Gianluca Botticelli ◽

Marco Severino ◽

Gianmaria Fabrizio Ferrazzano ◽

Pedro Vittorini Velasquez ◽

Carlo Franceschini ◽

...

Keyword(s):

Minor Salivary Gland ◽

Surgical Techniques ◽

Surgical Excision ◽

Complete Healing ◽

Surgical Removal ◽

Clinical Approach ◽

Lower Lip ◽

Impression Material ◽

Dental Impression

Oral mucocele is a benign cystic exophytic lesion affecting the minor salivary gland and is especially present in pediatric patients (3% under 14 years). It is characterized by an extravasation or retention of fluid or mucus in the submucosal tissue of the minor salivary glands. Several surgical techniques have been proposed over the years, including the excision of the mucocele by using the injection of a hydrocolloid impression material in the light of the cyst to prevent the collapse of the cystic wall and solidify the lesion, resulting in a better cleavage plan. The combined clinical approach between the combination of Shira’s technique and the surgical excision of the cystic lesion results in a conservative surgical removal of the lesion. Here, we reported the removal of a labial mucocele in a 14-year-old male patient, using the injection of a hydrocolloid impression material. At a 12 months follow up, the patient showed complete healing of the surgical site, showing a pinkish lip lining mucosa without scarring or recurrence of the primary lesion. The combined therapeutic approach between Shira’s technique and surgical excision allows a safe and predictable excision of the labial mucocele, minimizing the risk of recurrence.

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The concept of “Four Walls, Two Poles” in the lesions of the thalamus and ganglion regions: case report and literature review

BMC Surgery ◽

10.1186/s12893-021-01059-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Haiyang Yang ◽

Gang Bai ◽

Yongli Zhang ◽

Guolong Chen ◽

Lei Duan ◽

...

Keyword(s):

Basal Ganglia ◽

Literature Review ◽

Surgical Resection ◽

Three Dimensional ◽

Surgical Techniques ◽

Surgical Approaches ◽

Surgical Results ◽

Case Presentation ◽

Operation Process ◽

Thalamic Glioma

Abstract Background There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. Case presentation Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the “Four Walls, Two Poles”, lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the “Four Walls, Two Poles” has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. Conclusions In the presented three cases the three-dimensional concept of the “Four Walls, Two Poles” allowed for safe surgical resection of lesions of the thalamus and basal ganglia.

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Primary Malignant Orbital Tumors

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1722635 ◽

2021 ◽

Vol 82 (01) ◽

pp. 081-090

Author(s):

Jacquelyn Laplant ◽

Kimberly Cockerham

Keyword(s):

Multimodal Therapy ◽

Surgical Techniques ◽

Surgical Approaches ◽

Imaging Features ◽

Orbital Surgery ◽

Diagnosis And Management ◽

Microsurgical Techniques ◽

Invasive Techniques ◽

Traditional Approaches ◽

Orbital Imaging

Abstract Objective Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting Outpatient and inpatient hospital settings. Participants Patients with diagnosed primary orbital malignancies. Main Outcome Measures Descriptive outcomes. Results Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.

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Meningiomas Of the Internal Auditory Canal

Neurosurgery ◽

10.1227/01.neu.0000126887.55995.e7 ◽

2004 ◽

Vol 55 (1) ◽

pp. 119-128 ◽

Cited By ~ 36

Author(s):

Makoto Nakamura ◽

Florian Roser ◽

Sharham Mirzai ◽

Cordula Matthies ◽

Peter Vorkapic ◽

...

Keyword(s):

Cerebellopontine Angle ◽

Clinical Symptoms ◽

Management Strategies ◽

Internal Auditory Canal ◽

Signs And Symptoms ◽

Vestibular Schwannomas ◽

Additional Patient ◽

Surgical Removal ◽

Neurosurgical Department ◽

Vestibulocochlear Nerve

Abstract OBJECTIVE: Meningiomas arising primarily within the internal auditory canal (IAC) are notably rare. By far the most common tumors that are encountered in this region are neuromas. We report a series of eight patients with meningiomas of the IAC, analyzing the clinical presentations, surgical management strategies, and clinical outcomes. METHODS: The charts of the patients, including histories and audiograms, imaging studies, surgical records, discharge letters, histological records, and follow-up records, were reviewed. RESULTS: One thousand eight hundred meningiomas were operated on between 1978 and 2002 at the Neurosurgical Department of Nordstadt Hospital. Among them, there were 421 cerebellopontine angle meningiomas; 7 of these (1.7% of cerebellopontine angle meningiomas) were limited to the IAC. One additional patient underwent surgery at the Neurosurgical Department of the International Neuroscience Institute, where a total of 21 cerebellopontine angle meningiomas were treated surgically from 2001 to 2003. As a comparison, the incidence of intrameatal vestibular schwannomas during the same period, 1978 to 2002, was 168 of 2400 (7%). There were five women and three men, and the mean age was 49.3 years (range, 27–59 yr). Most patients had signs and symptoms of vestibulocochlear nerve disturbance at presentation. One patient had sought treatment previously for total hearing loss before surgery. No patient had a facial paresis at presentation. The neuroradiological workup revealed a homogeneously contrast-enhancing tumor on magnetic resonance imaging in all patients with hypointense or isointense signal intensity on T1- and T2-weighted images. Some intrameatal meningiomas showed broad attachment, and some showed a dural tail at the porus. In all patients, the tumor was removed through the lateral suboccipital retrosigmoid approach with drilling of the posterior wall of the IAC. Total removal was achieved in all cases. Severe infiltration of the facial and vestibulocochlear nerve was encountered in two patients. There was no operative mortality. Hearing was preserved in five of seven patients; one patient was deaf before surgery. Postoperative facial weakness was encountered temporarily in one patient. CONCLUSION: Although intrameatal meningiomas are quite rare, they must be considered in the differential diagnosis of intrameatal mass lesions. The clinical symptoms are very similar to those of vestibular schwannomas. A radiological differentiation from vestibular schwannomas is not always possible. Surgical removal of intrameatal meningiomas should aim at wide excision, including involved dura and bone, to prevent recurrences. The variation in the anatomy of the faciocochlear nerve bundle in relation to the tumor has to be kept in mind, and preservation of these structures should be the goal in every case.

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Tracheal surgery

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2010.294 ◽

2016 ◽

Vol 73 (3) ◽

Author(s):

A. D'Andrilli ◽

E.A. Rendina ◽

F. Venuta

Keyword(s):

Surgical Resection ◽

Surgical Techniques ◽

Treatment Modalities ◽

Malignant Neoplasms ◽

New Techniques ◽

Multidisciplinary Cooperation ◽

Post Traumatic ◽

Post Intubation ◽

Near Future

Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases.

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