scholarly journals Management of jugular bulb injury during retrosigmoid transmeatal resection of vestibular schwannoma

2021 ◽  
Vol 5 (2) ◽  
pp. V5
Author(s):  
Felipe Constanzo ◽  
Bernardo Correa de Almeida Teixeira ◽  
Mauricio Coelho Neto ◽  
Ricardo Ramina

Inadvertent laceration of the jugular bulb is a potentially serious complication of the retrosigmoid transmeatal approach to vestibular schwannomas. Here, the authors present the case of a 51-year-old woman with a right Hannover T4a vestibular schwannoma and bilateral high-riding jugular bulb, which was opened during drilling of the internal auditory canal (IAC). They highlight the immediate management of this complication, technical nuances for closing the defect without occluding the jugular bulb, and modifications of the standard technique needed to continue surgical resection. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2155

2021 ◽  
Vol 5 (2) ◽  
pp. V4
Author(s):  
Florian Roser ◽  
Tanmoy Maiti ◽  
Mohamed Samy Elhammady

The present surgical video demonstrates safe opening of the internal auditory canal (IAC) during vestibular schwannoma surgery via a retrosigmoid approach in the sitting position. Resection of the intrameatal portion of a tumor is important for progression-free survival. Preoperative thin-sliced CT revealed a high-riding jugular bulb obscuring the trajectory. After dural opening, the IAC was approached anteriorly and superiorly. The posterior margin of IAC drilling was above the Tubingen line. Drilling was performed under continuous jugular compression. The vein was pushed down to augment visibility. An angled endoscope was helpful. IAC can be drilled safely in a high-riding jugular bulb with the technique mentioned in the video. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2198


Author(s):  
Orest Palamar ◽  
Andriy Huk ◽  
Dmytro Okonskyi ◽  
Ruslan Aksyonov ◽  
Dmytro Teslenko

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).


2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Debebe Theodros ◽  
C. Rory Goodwin ◽  
Genevieve M. Crane ◽  
Jason Liauw ◽  
Lawrence Kleinberg ◽  
...  

Extrapulmonary small cell carcinomas (EPSCC) are rare malignancies with poor patient prognoses. We present the case of a 63-year-old male who underwent surgical resection of a poorly differentiated small cell carcinoma, likely from a small intestinal primary tumor that metastasized to the cerebellopontine angle (CPA). A 63-year-old male presented with mild left facial paralysis, hearing loss, and balance instability. MRI revealed a 15 mm mass in the left CPA involving the internal auditory canal consistent with a vestibular schwannoma. Preoperative MRI eight weeks later demonstrated marked enlargement to 35 mm. The patient underwent a suboccipital craniectomy and the mass was grossly different visually and in consistency from a standard vestibular schwannoma. The final pathology revealed a poorly differentiated small cell carcinoma. Postoperative PET scan identified avid uptake in the small intestine suggestive of either a small intestinal primary tumor or additional metastatic disease. The patient underwent whole brain radiation therapy and chemotherapy and at last follow-up demonstrated improvement in his symptoms. Surgical resection and radiotherapy are potential treatment options to improve survival in patients diagnosed with NET brain metastases. We present the first documented case of skull base metastasis of a poorly differentiated small cell carcinoma involving the CPA.


2021 ◽  
Vol 2 (18) ◽  
Author(s):  
Masato Ito ◽  
Yoshinori Higuchi ◽  
Kentaro Horiguchi ◽  
Shigeki Nakano ◽  
Shinichi Origuchi ◽  
...  

BACKGROUND Anatomical variations, such as high jugular bulbs and air cell development in the petrosal bone, should be evaluated before surgery. Most bone defects in the internal auditory canal (IAC) posterior wall are observed in the perilabyrinthine cells. An aberrant vascular structure passing through the petrous bone is rare. OBSERVATIONS A 48-year-old man presented with a right ear hearing disturbance. Magnetic resonance imaging revealed a 23-mm contrast-enhancing mass in the right cerebellopontine angle extending into the IAC, consistent with a right vestibular schwannoma. Preoperative bone window computed tomographic scans showed bone defects in the IAC posterior wall, which ran farther posteroinferiorly in the petrous bone, reaching the medial part of the jugular bulb. The tumor was accessed via a lateral suboccipital approach. There was no other major vein in the cerebellomedullary cistern, except for the vein running from the brain stem to the IAC posterior wall. To avoid complications due to venous congestion, the authors did not drill out the IAC posterior wall or remove the tumor in the IAC. LESSONS Several aberrant veins in the petrous bone are primitive head sinus remnants. Although rare, their surgical implication is critical in patients with vestibular schwannomas.


2014 ◽  
Vol 36 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Peter S. Amenta ◽  
Jacques J. Morcos

The cerebellopontine angle is the site for a wide-range of neoplastic and vascular pathologies. The retrosigmoid craniotomy remains the primary means by which to gain surgical access to this anatomically complex region. We present our standard technique for the completion of a retrosigmoid craniotomy and the resection of a left-sided vestibular schwannoma. Anatomy pertinent to the approach, including, the transverse and sigmoid sinuses, cranial nerves, and internal auditory canal (IAC) is displayed. Special emphasis is placed on patient positioning, adequate bone removal, and tumor resection. The drilling of the IAC and tumor dissection from the VII-VIII complex is also highlighted. Hearing preservation was achieved.The video can be found here: http://youtu.be/FFZju5vcBi0.


2021 ◽  
Vol 5 (2) ◽  
pp. V9
Author(s):  
Gustavo S. Jung ◽  
Joel Fernando Sanabria Duarte ◽  
Afonso H. de Aragão ◽  
Ronaldo Pereira Vosgerau ◽  
Ricardo Ramina

The course of the facial nerve (FN) has been extensively investigated in patients with vestibular schwannomas (VSs). FN running dorsally to the tumor capsule accounts for less than 3% of the cases. Diffusion tensor imaging (DTI)–based fiber tracking helps to preoperatively identify the FN. During surgery, a higher risk of injury is associated with the dorsal location of the FN. The authors demonstrate the nuances and tricks to identify and preserve a dorsal displaced FN during resection of a large VS, T3b according to the Hannover classification, through the retrosigmoid-transmeatal approach. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2182


2003 ◽  
Vol 117 (10) ◽  
pp. 788-792 ◽  
Author(s):  
Mario Sanna ◽  
Manoj Agarwal ◽  
Yogesh Jain ◽  
Alessandra Russo ◽  
Abdel Kader Taibah

Difficult cerebellopontine angle (CPA) tumours namely large/giant vestibular schwannomas, vestibular schwannomas with a significant anterior extension and meningiomas of the posterior surface of the petrous bone extending anterior to the internal auditory canal (IAC) have always posed a problem for the otoneurosurgeon. Modifications of the enlarged translabyrinthine approach (ETLA) specifically aimed at dealing with these tumours are not reported. The aim of this paper is to introduce the transapical extension of ETLA which involves increased circumferential drilling around the IAC beyond 270°C. The extension allows enhanced surgical control over the tumour as well as the anterior aspect of the CPA including the prepontine cistern, the Vth and VIth cranial nerves. The extension is further classified into Type I and II depending upon the extent of drilling. Type I extension entails drilling around the IAC for 300–320° and is indicated for large/giant vestibular schwannomas (large vestibular schwannoma extrameatal diameter 3–3.9 cm, giant vestibular schwannoma extrameatal diameter [ges ]4 cm) and vestibular schwannomas with significant anterior extension. Type II extension involves complete drilling around the canal for 360° and is indicated for meningiomas of the posterior surface of the petrous bone extending anterior to the IAC.


2016 ◽  
Vol 125 (6) ◽  
pp. 1469-1471 ◽  
Author(s):  
Gautam U. Mehta ◽  
Michael J. Feldman ◽  
Herui Wang ◽  
Dale Ding ◽  
Prashant Chittiboina

The presence of vestibular schwannomas has long been considered an exclusion criterion for the diagnosis of schwannomatosis. Recently, 2 cases of vestibular schwannoma were reported in patients with schwannomatosis, leading to a revision of the diagnostic criteria for this genetic disorder. Overall, the relative infrequency of vestibular schwannomas in schwannomatosis is unexplained, and the genetics of this uncommon phenomenon have not been described. The authors report on a family with clinical manifestations consistent with schwannomatosis, including 4 affected members, that was identified as having an affected member harboring a unilateral cerebellopontine angle mass with extension into the internal auditory canal. Radiologically, this mass was consistent with a vestibular schwannoma and resulted in a symptomatic change in ipsilateral hearing (word recognition 86% at 52 dB) and increased latency of the wave I–V interval on auditory brainstem response testing. The patient was found to be negative for a germline mutation of NF2 and LZTR1, and her affected mother was found to harbor neither NF2 nor SMARCB1 mutations on genetic testing. Although vestibular schwannomas have been classically considered to not occur in the setting of schwannomatosis, this patient with schwannomatosis and a vestibular schwannoma further confirms that schwannomas can occur on the vestibular nerve in this syndrome. Further, this is the first such case found to be negative for a mutation on the LZTR1 gene.


2018 ◽  
Vol 80 (S 03) ◽  
pp. S272-S273
Author(s):  
Georgios Klironomos ◽  
Amir Reza Dehdashti

Particular care to facial nerve function preservation should be the ultimate goal in surgery for large vestibular schwannomas. We present a 60-year-old patient who presented with an enlarging right vestibular schwannoma and nonserviceable hearing. The patient was operated in the semisitting position after a patent foramen ovale was ruled out. During the positioning, the feet were positioned at the level of the heart. Precordial Doppler was used to monitor for air embolism. Straight skin incision and retrosigmoid craniotomy was performed. Specific attention to venous bleeding was made during the approach. Meticulous arachnoid dissection of the capsule preserving the arachnoid plane at the surface of the brain stem and the facial nerve can be achieved more efficiently with the patient in the semisiting position and with bimanual microdissection technique. After drilling of the internal auditory canal (IAC), we were able to achieve near total removal of the tumor, leaving a tiny tumor carpet due to extreme adherence to the nerve. Water-tight dura closure and replacement of the bone flap was performed. The patient woke up with a House–Brackmann grade III facial weakness which improved to grade I at 6 weeks postoperatively. Postoperative magnetic resonance imaging (MRI) showed a tiny residual at the surface of the facial nerve at the entrance of the IAC. Near total (> 98%) resection of large vestibular schwannomas is an acceptable surgical strategy with excellent facial nerve outcome. With appropriate patient positioning in semisitting and proper anesthesiological and surgical management, the risk of air embolism is negligible.The link to video can be found at: https://youtu.be/ErG9VexbiGw.


1994 ◽  
Vol 108 (11) ◽  
pp. 986-988 ◽  
Author(s):  
Martin J. Donnelly ◽  
Anne D. Cass ◽  
Laurie Ryan

AbstractThe current gold standard for diagnosing vestibular schwannomas is MRI with gadolinium-DTPA enhancement. This imaging modality is particularly useful in the detection of small intracanalicular tumours which can be missed by CT scanning. We present a case where MRI with enhancement suggested the presence of a 4 mm intracanalicular vestibular schwannoma. Surgical exploration of the internal auditory canal via a retrosigmoid approach, revealed no tumour, but inflammatory arachnoid matter around the vestibular nerve was found. A review of the audiological test results uncovered some results which did not correlate with the interpretation of the MRI scan. We would therefore caution against immediate surgical intervention in patients where the diagnosis of a small intracanalicular vestibular schwannoma is not totally supported by the audiological findings. In such cases rescanning with gadolinium enhancement after a suitable interval is recommended.


Sign in / Sign up

Export Citation Format

Share Document