scholarly journals Hearing preservation middle fossa approach for intracanalicular vestibular schwannoma in a NF2 patient

2021 ◽  
Vol 5 (2) ◽  
pp. V13
Author(s):  
Claudio H. F. Vidal ◽  
Yoav Hahn ◽  
Mariana C. Leal ◽  
Kiara Medeiros ◽  
Gabriela F. Hazin ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Postoperative Period ◽  
Internal Auditory Canal ◽  
Decisive Role ◽  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Individual Experience ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Potential Benefits

Hearing preservation is a cornerstone in the management of intracanalicular vestibular schwannomas. This video demonstrates a middle fossa approach to an intracanalicular schwannoma and highlights some technical and anatomical nuances relevant to the procedure. The patient had sustained hearing preservation in the postoperative period. There are potential benefits in favor of the middle fossa when the tumor reaches the fundus of the internal auditory canal, but the surgeon’s individual experience plays a decisive role in the choice of approach. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21121

Is the middle fossa approach the treatment of choice for intracanalicular vestibular schwannoma?

2005 ◽  
Vol 132 (3) ◽  
pp. 459-466 ◽  
Author(s):  
Vittorio Colletti ◽  
Francesco Fiorino
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Selection Criteria ◽  
Surgical Techniques ◽  
Internal Auditory Canal ◽  
Hearing Preservation ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Class A ◽  
Longitudinal Investigation

OBJECTIVES: To compare the 2 surgical techniques most commonly used during vestibular schwannoma (VS) surgery, i.e., the middle fossa (MF) and the retrosigmoid-transmeatal (RS-TM) routes, when hearing preservation is attempted. STUDY DESIGN: A longitudinal study of a series of consecutive patients operated on with the 2 techniques by the same surgeon was conducted. Selection criteria included tumor confined to the internal auditory canal (IAC) with a length ranging from 4 to 12 mm and hearing class A or B. Patients were alternately assigned to 1 of the 2 groups regardless of auditory class and distance of the tumor from the IAC fundus. Thirty-five subjects were operated on with the RS-TM technique and 35 via the MF route. RESULTS: No significant differences in auditory and facial nerve function results between the 2 techniques were observed. The RS-TM approach, however, showed better facial nerve results at discharge. VS size, IAC enlargement, and, particularly, the distance from the IAC fundus were found to influence the postoperative results more than the type of approach itself. CONCLUSIONS: The MF approach has been described as being the better technique for VS surgery in terms of auditory results. However, this claim lacks statistical substantiation because no prospective studies are to be found in the literature. The present longitudinal investigation shows that the MF approach does not afford any particular advantages over the RS-TM route in terms of auditory results in intracanalicular VS, with the exception of tumors reaching the IAC fundus.

Optimal outcomes for hearing preservation in the management of small vestibular schwannomas

2016 ◽  
Vol 130 (7) ◽  
pp. 606-610 ◽  
Author(s):  
K A Peng ◽  
E P Wilkinson
Keyword(s):  
Hearing Preservation ◽  
Vestibular Schwannomas ◽  
Middle Fossa ◽  
Stereotactic Radiation ◽  
Middle Fossa Approach ◽  
Small Tumour ◽  
Optimal Outcomes ◽  
Definitive Therapy ◽  
Hearing Outcomes

AbstractObjective:To undertake a systematic review of the role of microsurgery, in relation to observation and stereotactic radiation, in the management of small vestibular schwannomas with serviceable hearing.Methods:The Medline database was searched for publications that included the terms ‘vestibular schwannoma’ and/or ‘acoustic neuroma’, occurring in conjunction with ‘hearing’. Articles were manually screened to identify those concerning vestibular schwannomas under 1.5 cm in greatest dimension. Thereafter, only publications discussing both pre-operative and post-operative hearing were considered.Results:Twenty-six papers were identified. Observation is an acceptable strategy for small tumours with slow growth where hearing preservation is not a consideration. In contrast, microsurgery, including the middle fossa approach, may provide excellent hearing outcomes, particularly when a small tumour has begun to cause hearing loss. Immediate post-operative hearing usually predicts long-term hearing. Recent data on stereotactic radiation suggest long-term deterioration of hearing following definitive therapy.Conclusion:In patients under the age of 65 years with small vestibular schwannomas, microsurgery via the middle fossa approach offers durable preservation of hearing.

Hearing Preservation Using the Middle Fossa Approach for the Treatment of Vestibular Schwannoma

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 334-341 ◽  
Author(s):  
Joe Walter Kutz ◽  
Tyler Scoresby ◽  
Brandon Isaacson ◽  
Bruce E. Mickey ◽  
Christopher J. Madden ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Academic Medical Center ◽  
Hearing Preservation ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Class A ◽  
Facial Function ◽  
Grade Iii

Abstract BACKGROUND: The incidence of small vestibular schwannomas in patients with serviceable hearing is increasing because of the widespread use of MRI. The middle fossa approach provides the patient with an opportunity for tumor removal with hearing preservation. OBJECTIVE: To determine the rate of hearing preservation and facial nerve outcomes after removal of a vestibular schwannoma with the use of the middle fossa approach. METHODS: A retrospective case review at a tertiary, academic medical center was performed identifying patients from 1998 through 2008 that underwent removal of a vestibular schwannoma by the middle fossa approach. Preoperative and postoperative audiograms were compared to determine hearing preservation rates. In addition, facial nerve outcomes at last follow-up were recorded. RESULTS: Forty-six patients underwent a middle fossa craniotomy for the removal of a vestibular schwannoma. Of the 38 patients that had class A or class B hearing preoperatively, 24 (63.2%) retained class A or B hearing and 29 (76.3%) retained class A, B, or C hearing. When tumors were 10 mm or less in patients with class A or B preoperative hearing, 22 of 30 patients (73.3%) retained class A or B hearing. When the tumor size was greater than 10 mm in patients with class A or B preoperative hearing, 2 of 8 patients (25%) retained class A or B hearing. At most recent follow-up, 76.1% of patients had House-Brackmann grade I facial function, 13.0% had House-Brackmann grade II facial function, and 10.9% had House-Brackmann grade III facial function. CONCLUSION: Hearing preservation rates are excellent using the middle fossa approach, especially for smaller tumors. No patient experienced long-term facial nerve function worse than House-Brackmann grade III.

Influence of Vestibular Schwannoma Morphology on Hearing Preservation in Patients Operated by the Middle Fossa Approach

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Kazimierz Niemczyk ◽  
Krzysztof Morawski ◽  
Andrzej Marchel ◽  
Antoni Bruzgielewicz ◽  
Arkadiusz Nowak ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Middle Fossa ◽  
Middle Fossa Approach

Late Failure Rate of Hearing Preservation After Middle Fossa Approach for Resection of Vestibular Schwannoma

2011 ◽  
Vol 32 (1) ◽  
pp. 132-135 ◽  
Author(s):  
Christopher W. Hilton ◽  
Stephen J. Haines ◽  
Ankit Agrawal ◽  
Samuel C. Levine
Keyword(s):  
Failure Rate ◽  
Vestibular Schwannoma ◽  
Hearing Preservation ◽  
Middle Fossa ◽  
Middle Fossa Approach ◽  
Late Failure

The history of neurosurgery at the House Clinic in Los Angeles

2020 ◽  
Vol 133 (3) ◽  
pp. 749-755 ◽  
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.

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).

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