Usefulness of the radiological planning for hearing preservation surgery in vestibular schwannoma

Krystkiewicz, Kamil; Skadorwa, Tymon; Szaro, Paweł; Ciszek, Bogdan

doi:10.1007/s00276-016-1668-z

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…At least three parameters are required to define a drilling range: the length of lateral drilling, the length of the drilled posterior wall of IAC, and the drilling angle. The length of lateral drilling was proposed by some experts to be 10 ± 2 mm ( 28 ). The length of drilled posterior wall of IAC ranged from 5 to 10 mm, according to the present literature ( 28 – 30 ).…”

Section: Discussionmentioning

confidence: 99%

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

Gao

et al. 2022

Front. Oncol.

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ObjectiveTo explore the role of neuroendoscope assistance during surgical resection of the intracanalicular portion of vestibular schwannomas via the retrosigmoid approach and the subsequent early facial nerve outcomes.MethodsPatients of vestibular schwannoma with intracanalicular extensions undergoing retrosigmoid dissection at a single institution were retrospectively analyzed in this study. Several surgical techniques were applied to ensure maximal and safe removal of tumors. Tumors extending less than 10 mm into the internal acoustic canal (IAC) were classified as Grade A, while those extending over 10 mm into IAC were taken as Grade B. Neuroendoscope was applied at the end of microscopic phase to search for potential remnants for Grade B tumors. Absolute tumor extension was defined and measured. House and Brackmann (HB) scale was used to evaluate immediate CN VII outcomes.ResultsOf the 61 patients, there were 38 females and 23 males. A total of 18 (29.51%) cases were Koos Grade II, 12 (19.67%) cases Koos Grade III, and 31 (50.82%) cases Koos Grade IV. There were 38 cases (62.30%) of Grade A and 23 cases (37.70%) of Grade B. Gross total resection was achieved in 60 cases (98.36%). Four cases of intracanalicular remnants were detected and completely removed under endoscopic visualizations. There was a significantly higher proportion (17%, p = 0.02) of intracanalicular remnants in Grade B than Grade A. CN VII and VIII were anatomically preserved in all cases. A total of 55 cases (90.16%) retained good (HB Grades 1 and 2) facial nerve outcomes.ConclusionsIn Grade B vestibular schwannomas, after maximal microsurgical removal, endoscopic evaluation of the intracanalicular portion revealed residual tumors in 17% of the patients. Hence endoscopic evaluation of the potential intracanalicular remnants for tumor extending over 10 mm within IAC (Grade B) is recommended.

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Section: Discussionmentioning

confidence: 99%

“…The length of lateral drilling was proposed by some experts to be 10 ± 2 mm ( 28 ). The length of drilled posterior wall of IAC ranged from 5 to 10 mm, according to the present literature ( 28 – 30 ). Using frameless navigation on 10 cadaveric heads, Pillai et al.…”

Section: Discussionmentioning

confidence: 99%

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

Gao

et al. 2022

Front. Oncol.

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Topographic anatomy of the endolymphatic sac: a pilot cadaveric dissection study

Yeşilova,

Bal,

Güven

et al. 2024

Surg Radiol Anat

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A hearing preservation technique for acoustic neuroma resection via retrosigmoid sinus approach

Zeng

Chen

et al. 2023

Preprint

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Background: Acoustic neuroma, also known as vestibular schwannoma, is a non-cancerous tumor that accounts for up to 90% of all cerebellopontine angle (CPA) tumors. The treatment for acoustic neuroma typically involves surgical removal of the tumor. The most common surgical approach is translabyrinthine surgery, which involves resection of the tumor in the inner auditory canal (IAC) and in the cerebellopontine horn area. Adequate excision of the IAC is essential for complete tumor removal from this area. However, this type of surgery can result in injuries to the inner ear, leading to hearing loss and balance problems. Advances in surgical techniques for IAC resection have improved canal exposure without causing significant damage to the inner ear. Objective: Preoperative imaging, such as three-dimensional (3D) high-resolution computed Tomography (HRCT), can be used to calculate the optimal resection angles for IAC excision. These images provide detailed information on the location and size of the tumor, as well as the surrounding structures in the ear. Methods: This study included 256 patients diagnosed with unilateral acoustic neuroma who underwent HRCT scans before and after surgery. Images were acquired and analyzed using the Syngo 2008G workstation. IAC was then assessed and surgery was planned based on the acquired HRCT images. Results: The optimal angle of grinding for the labyrinth was 42.3°, which allowed for IAC resection in 76.3% patients and total tumor resection in 94.1% patients as well as ensured the integrity of the labyrinth during the surgical procedure. Conclusion: We hope that our method of calculation will serve as a useful guide for practicing surgeons when performing this complex surgery. We anticipate that with the application of endoscope-assisted neurosurgical technique and electrophysiological monitoring, the preservation of facial and vestibulocochlear nerve functions in acoustic neuroma surgery will be further improved.

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Usefulness of the radiological planning for hearing preservation surgery in vestibular schwannoma

Cited by 3 publications

References 11 publications

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

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

Topographic anatomy of the endolymphatic sac: a pilot cadaveric dissection study

A hearing preservation technique for acoustic neuroma resection via retrosigmoid sinus approach

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