Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Bi, Yunke; Ni, Yunjia; Gao, Dandan; Zhu, Qingwei; Zhou, Qiangyi; Tang, Juan; Liu, Juan; Shi, Fei; Li, Hongchan; Yin, Jian; Liu, Yaohua; Lou, Meiqing

doi:10.3389/fonc.2021.774462

Cited by 4 publications

(4 citation statements)

References 34 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An increase in tumor size can increase postoperative complications, due to the formation of more adhesion bands between tumor mass and other adjacent structures such as the brainstem, thus patients are at a higher risk of developing respiratory failure within 24 hours postoperatively ( 9 ). At present, an endoscopic-assisted technique for more complex cases of VS has been adopted widely by increasing numbers of neurosurgeons, due to the technological advancement of endoscopic-assisted microsurgery and improved intraoperative neurophysiological monitoring technology ( 10 , 11 ). Endoscopic-assisted microsurgery has greatly reduced postoperative complications, significantly improved the tumor resection rate, and notably has improved the quality of life of patients ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of the effect of neuroendoscopy-assisted microscopy in the treatment of Large (Koos grade IV) vestibular schwannoma

Yang

Xiong²,

Jian³

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

IntroductionThis article aimed to investigate the effects of the endoscopic-assisted microsurgery technique on the resection of large (Koos grade IV) vestibular schwannoma (VS) and provide a prognosis analysis of the patients.MethodsA retrospective analysis of the use of the endoscopic-assisted microsurgery technique in 16 cases of large vestibular schwannoma surgery was carried out. Intraoperative nerve electrophysiological monitoring was conducted to explore the effect of neuroendoscopy on the resection of internal auditory canal tumors, protection of the facial nerve, and minimizing postoperative complications.ResultsTumors were completely removed in all 16 cases, and the facial nerve was anatomically preserved in 14 cases (87.5%). There was no postoperative cerebrospinal fluid leakage and no intracranial infection complications occurred.Following the House-Brackmann (H-B) grading system, post-operative facial nerve function was grade I in 5 cases, grade II in 6 cases, grade III in 3 cases, and grade V in 2 cases. As a result, the preservation rate of facial nerve function (H-B grade I-II) was 68.8%. All 16 patients were followed up for 3 to 24 months, and no tumor recurrence was found on enhanced MRI.DiscussionUsing the endoscopic-assisted microsurgery technique in the retrosigmoid approach has many advantages over the microscopic-only approach. When compared to the microscopy-only approach, the endoscope can provide a wide-angle surgical field superior to that of a microscope in areas such as the internal auditory canal in the resection of large VS, minimize iatrogenic injuries, ensure complete removal of internal auditory canal tumors, and well as reducing postoperative complications such as cerebrospinal fluid leakage and the loss of facial and auditory nerve functions.

show abstract

Section: Discussionmentioning

confidence: 99%

Analysis of the effect of neuroendoscopy-assisted microscopy in the treatment of Large (Koos grade IV) vestibular schwannoma

Yang

Xiong²,

Jian³

et al. 2023

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…Post‐surgical persistent FN dysfunction, defined as HB‐III or higher at last follow‐up, significantly depends on tumor volume and Koos grade, unsurprisingly, with worse facial outcomes after resection of larger tumors 45 . For Koos‐I to Koos‐III schwannomas, recently reported rates of persistent post‐surgical FN dysfunction range from 6.2% to 10.1% after the middle fossa approach, 46–48 2.3%–9.8% after the retrosigmoid approach, 48–50 and 10.7%–16.4% after the translabyrinthine approach 48,50 . The pooled rates of persistent FN palsy after transpromontorial approaches for Koos‐I to Koos‐III schwannomas were higher (12.7%), likely due to the heterogeneous surgical experience with this recent approach across different institutions and the limited comprehensive number of treated patients.…”

Section: Discussionmentioning

confidence: 99%

Transcanal Transpromontorial Approaches to the Internal Auditory Canal: A Systematic Review

et al. 2023

View full text Add to dashboard Cite

ObjectiveExclusive endoscopic (EETTA) and expanded (ExpTTA) transcanal transpromontorial approaches have shown promising results for treating internal auditory canal (IAC) lesions. We reviewed the literature to answer the question: “Do EETTA and ExpTTA achieve high rates of complete resection and low rates of complications in treating patients with IAC pathologies?”Data SourcesPubMed, EMBASE, Scopus, Web of Science, and Cochrane were searched.Review MethodsStudies reporting EETTA/ExpTTA for IAC pathologies were included. Indications and techniques were discussed and meta‐analyzed rates of outcomes and complications were obtained with random‐effect model meta‐analyses.ResultsWe included 16 studies comprising 173 patients, all with non‐serviceable hearing. Baseline FN function was mostly House‐Brackmann‐I (96.5%; 95% CI: 94.9–98.1%). Most lesions were vestibular/cochlear schwannomas (98.3%; 95% CI: 96.7–99.8%) of Koos‐I (45.9%; 95% CI: 41.3–50.3%) or II (47.1%; 95% CI: 43–51.1%). EETTA was performed in 101 patients (58.4%; 95% CI: 52.4–64.3%) and ExpTTA in 72 (41.6%; 95% CI: 35.6–47.6%), achieving gross‐total resection in all cases. Transient complications occurred in 30 patients (17.3%; 95% CI: 13.9–20.5%), with meta‐analyzed rates of 9% (95% CI: 4–15%), comprising FN palsy with spontaneous resolution (10.4%; 95% CI: 7.7–13.1%). Persistent complications occurred in 34 patients (19.6%; 95% CI: 17.1–22.2%), with meta‐analyzed rates of 12% (95% CI: 7–19%), comprising persistent FN palsy in 22 patients (12.7%; 95% CI: 10.2–15.2%). Mean follow‐up was 16 months (range, 1–69; 95% CI: 14.7–17.4). Post‐surgery FN function was stable in 131 patients (75.8%; 95% CI: 72.1–79.5%), worsened in 38 (21.9%; 95% CI: 18.8–25%), and improved in 4 (2.3%; 95% CI: 0.7–3.9%), with meta‐analyzed rates of improved/stable response of 84% (95% CI: 76–90%).ConclusionTranspromontorial approaches offer newer routes for IAC surgery, but their restricted indications and unfavorable FN outcomes currently limit their use. Laryngoscope, 2023

show abstract

“…For the surgical management of VSs, three main approaches can be utilized: the retrosigmoid, the translabyrinthine, and the middle fossa approach, or sometimes combinations or variations of these [1][2][3][4][5]. Besides these most widely used approaches, there are other combinations and variations that could be utilized in some selected cases, but with limited indications [6][7][8][9]. Factors such as the size and extension of the tumor and the patient's hearing status play crucial roles in the choice of surgical approach.…”

Section: Introductionmentioning

confidence: 99%

Two-Stage Surgical Management for Acutely Presented Large Vestibular Schwannomas: Report of Two Cases

Keles,

Ozaydin,

Erginoglu

et al. 2023

Brain Sciences

View full text Add to dashboard Cite

The surgical management of vestibular schwannomas should be based on their presentation, neuro-imaging findings, surgeons’ expertise, and logistics. Multi-stage surgery can be beneficial for large-sized lesions with acute presentations. Herein, we highlighted the indications for two cases managed initially through the retrosigmoid and, subsequently, translabyrinthine approaches. The first case presented with acute balance and gait issues and a long history of hearing loss and blurred vision. Neuroimaging findings revealed a cerebellopontine angle lesion, resembling a vestibular schwannoma, with significant brainstem compression and hydrocephalus. Due to the rapidly deteriorating clinical status and large-sized tumor, we first proceeded with urgent decompression via a retrosigmoid approach, followed by gross total resection via a translabyrinthine approach two weeks later. The second case presented with gradually worsening dizziness and hemifacial numbness accompanied by acute onset severe headaches and hearing loss. Neuroimaging findings showed a large cerebellopontine angle lesion suggestive of a vestibular schwannoma with acute intratumoral hemorrhage. Given the acute clinical deterioration and large size of the tumor, we performed urgent decompression with a retrosigmoid approach followed by gross total resection through a translabyrinthine approach a week later. Post-surgery, both patients showed excellent recovery. When managing acutely presented large-sized vestibular schwannomas, immediate surgical decompression is vital to avoid permanent neurological deficits.

show abstract

Endoscope-Assisted Retrosigmoid Approach for Vestibular Schwannomas With Intracanalicular Extensions: Facial Nerve Outcomes

Cited by 4 publications

References 34 publications

Analysis of the effect of neuroendoscopy-assisted microscopy in the treatment of Large (Koos grade IV) vestibular schwannoma

Analysis of the effect of neuroendoscopy-assisted microscopy in the treatment of Large (Koos grade IV) vestibular schwannoma

Transcanal Transpromontorial Approaches to the Internal Auditory Canal: A Systematic Review

Two-Stage Surgical Management for Acutely Presented Large Vestibular Schwannomas: Report of Two Cases

Contact Info

Product

Resources

About