Resection of a meningioma, vestibular schwannoma, and placement of auditory brainstem implant using translabyrinthine approach

The authors present the case of a 34-year-old patient with neurofibromatosis type 2 (NF-2) who underwent a left translabyrinthine approach for resection a meningioma, vestibular schwannoma, and placement of an auditory brainstem implant (ABI). They review the preoperative workup, technical nuances of the surgery, and cadaveric dissections with anatomical diagrams, and provide a review on ABIs. The patient remained neurologically intact and had improvement in lip reading when using the ABI device in the postoperative period. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2163

747 IS 99MTC BONE SCINTIGRAPHY NECESSARY IN THE PREOPERATIVE WORKUP FOR PATIENTS WITH POTENTIALLY RESECTABLE ESOPHAGEAL SQUAMOUS CELL CANCER?

99mTc bone scintigraphy(BS) is still the most widely used method to evaluate bone metastasis in China. The aim of this study was to investigate the necessity of the 99mTc bone scintigraphy in the preoperative workup for patients with potentially resectable esophageal squamous cell cancer (ESCC,cT1-4aN0–3). Methods This was a prospective cross-section clinical trial (ChiCTR1800020304). There were a total of 471 patients who were diagnosed ESCC in Thoracic Surgery Clinic from October 2018 to September 2020. Of these 471 patients, 385 patients with cT1-4aN0–3 who were potentially candidates for surgical resection were consecutively enrolled into the study. BS was performed preoperatively. The treatment strategy could be changed if the bone metastasis was confirmed. The primary endpoint was the incidence rate of the treatment regimen being changed because of bone metastasis. The secondary endpoint was the rate of positive BS findings. Results In all 385 patients, there are only 2(0.5%) patients changed their treatment regimen because of bone metastasis proved by BS. The rate of positive BS findings is 1%. The number of patients with false positive and false negative was 2(0.5%) and 2 (0.5%), respectively. The BS diagnostic performance for bone metastasis was as follows: sensitivity, 50%; specificity, 99.5%; positive predictive value, 50%; negative predictive value, 99.5% and accuracy, 99.0%. There were no significant difference of bone metastasis among the Age, Sex, Tumor location and Clinical stage. Conclusion 99mTc bone scintigraphy is unnecessary in the preoperative workup for patients with potentially resectable esophageal squamous cell cancer.

Intraoral transnasal approach for surgical extraction of bilateral deeply impacted mesiodens: A case report

Traditional palatal and vestibular surgical approaches for removing deeply impacted mesiodens with a crown facing the nasal floor are accompanied by significant complications. Herein, we describe a novel modified intranasal approach to minimize the complications. Also, it can be performed under local anesthesia with proper preoperative workup.

Extra-axial tentorial medulloblastoma: a rare presentation of a common posterior fossa tumour

Medulloblastoma is a common paediatric posterior fossa tumour typically presenting as midline intra-axial mass involving the cerebellar vermis and/or roof of fourth ventricle with typical radiological features. These can be extra-axial in extremely rare instances with less than 50 cases reported so far in literature. We present a case of 18-year-old boy presenting with ataxia and headache. MRI showed dural mass (involving the left tentorium cerebellum) with typical imaging features of extra-axial lesion. The patient underwent near total excision of the tumour. Histopathology along with immunohistochemistry revealed the mass to be medulloblastoma. We present this case to highlight rarity of this location for medulloblastoma and the importance of considering this in the differential diagnosis of atypical posterior fossa extra-axial lesions. This can help in performing other relevant preoperative workup similar on the lines of medulloblastoma and planning of relevant management.