RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0034-1543974
Endoscopic Resection of Vestibular Schwannomas
Publikationsverlauf
30. September 2014
16. November 2014
Publikationsdatum:
21. Januar 2015 (online)
Abstract
Objective To report our results and the technical details of fully endoscopic resection of vestibular schwannomas.
Design Prospective observational study.
Setting A single academic institution involving neurosurgery and neurotology.
Participants Twelve consecutive patients who underwent fully endoscopic resection of a vestibular schwannoma.
Main Outcome Measures Hearing preservation, based on the American Association of Otolaryngology-Head and Neck Surgeons (AAO-HNS) score as well as the Gardener and Robertson Modified Hearing Classification (GR). Facial nerve preservation based on the House-Brackmann (HB) score.
Results All patients successfully underwent gross total resection. Facial nerve preservation rate was 92% with 11 of 12 patients retaining an HB score of 1/6 postoperatively. Hearing preservation rate was 67% with 8 of 12 patients maintaining a stable AAO-HNS grade and GR score at follow-up. Mean tumor size was 1.5 cm (range: 1–2 cm). No patients experienced postoperative cerebrospinal fluid leak, infection, or cranial nerve palsy for a complication rate of 0%. Mean operative time was 261.6 minutes with an estimated blood loss of 56.3 mL and average length of hospital stay of 3.6 days.
Conclusion A purely endoscopic approach is a safe and effective option for hearing preservation surgery for vestibular schwannomas in appropriately selected patients.
-
References
- 1 Mouton WG, Bessell JR, Maddern GJ. Looking back to the advent of modern endoscopy: 150th birthday of Maximilian Nitze. World J Surg 1998; 22 (12) 1256-1258
- 2 Doyen E. Surgical Therapeutics and Operative Techniques. Vol 1. London, England: Balliere, Tindall, and Cox; 1917: 599-602
- 3 Borucki L, Szyfter W, Leszczyńska M. Microscopy and endoscopy of the cerebellopontine angle in the retrosigmoid approach [in Polish]. Otolaryngol Pol 2004; 58 (3) 509-515
- 4 Cappabianca P, Cavallo LM, Esposito F, de Divitiis E, Tschabitscher M. Endoscopic examination of the cerebellar pontine angle. Clin Neurol Neurosurg 2002; 104 (4) 387-391
- 5 Magnan J, Chays A, Lepetre C, Pencroffi E, Locatelli P. Surgical perspectives of endoscopy of the cerebellopontine angle. Am J Otol 1994; 15 (3) 366-370
- 6 O'Donoghue GM, O'Flynn P. Endoscopic anatomy of the cerebellopontine angle. Am J Otol 1993; 14 (2) 122-125
- 7 Takemura Y, Inoue T, Morishita T, Rhoton Jr AL. Comparison of microscopic and endoscopic approaches to the cerebellopontine angle. World Neurosurg 2014; 82 (3–4) 427-441
- 8 Van Rompaey J, Bush C, McKinnon B, Solares AC. Minimally invasive access to the posterior cranial fossa: an anatomical study comparing a retrosigmoidal endoscopic approach to a microscopic approach. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (1) 1-6
- 9 Wackym PA, King WA, Meyer GA, Poe DS. Endoscopy in neuro-otologic surgery. Otolaryngol Clin North Am 2002; 35 (2) 297-323
- 10 Artz GJ, Hux FJ, Larouere MJ, Bojrab DI, Babu S, Pieper DR. Endoscopic vascular decompression. Otol Neurotol 2008; 29 (7) 995-1000
- 11 Eby JB, Cha ST, Shahinian HK. Fully endoscopic vascular decompression of the facial nerve for hemifacial spasm. Skull Base 2001; 11 (3) 189-197
- 12 Halpern CH, Lang SS, Lee JY. Fully endoscopic microvascular decompression: our early experience. Minim Invasive Surg 2013; 2013: 739432
- 13 Jarrahy R, Eby JB, Cha ST, Shahinian HK. Fully endoscopic vascular decompression of the trigeminal nerve. Minim Invasive Neurosurg 2002; 45 (1) 32-35
- 14 Setty P, Volkov AA, D'Andrea KP, Pieper DR. Endoscopic vascular decompression for the treatment of trigeminal neuralgia: clinical outcomes and technical note. World Neurosurg 2014; 81 (3–4) 603-608
- 15 Yadav YR, Parihar V, Agarwal M, Sherekar S, Bhatele P. Endoscopic vascular decompression of the trigeminal nerve. Minim Invasive Neurosurg 2011; 54 (3) 110-114
- 16 American Academy of Otolaryngology-Head and Neck Surgery. Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 1995; 113 (3) 179-180
- 17 Broggi M, Ferroli P, Acerbi F, Tringali G, Franzini A, Broggi G. The value of endoscopy in microvascular decompression procedures. Neurosurgery 2012; 71 (2) E564
- 18 Chen MJ, Zhang WJ, Yang C, Wu YQ, Zhang ZY, Wang Y. Endoscopic neurovascular perspective in microvascular decompression of trigeminal neuralgia. J Craniomaxillofac Surg 2008; 36 (8) 456-461
- 19 Duntze J, Litré CF, Eap C , et al. Adjunctive use of endoscopy during microvascular decompression in the cerebellopontine angle: 27 case reports [in French]. Neurochirurgie 2011; 57 (2) 68-72
- 20 El-Garem HF, Badr-El-Dine M, Talaat AM, Magnan J. Endoscopy as a tool in minimally invasive trigeminal neuralgia surgery. Otol Neurotol 2002; 23 (2) 132-135
- 21 Jarrahy R, Berci G, Shahinian HK. Endoscope-assisted microvascular decompression of the trigeminal nerve. Otolaryngol Head Neck Surg 2000; 123 (3) 218-223
- 22 King WA, Wackym PA, Sen C, Meyer GA, Shiau J, Deutsch H. Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies. Neurosurgery 2001; 49 (1) 108-115 ; discussion 115–116
- 23 Miyazaki H, Deveze A, Magnan J. Neuro-otologic surgery through minimally invasive retrosigmoid approach: endoscope assisted microvascular decompression, vestibular neurotomy, and tumor removal. Laryngoscope 2005; 115 (9) 1612-1617
- 24 Rak R, Sekhar LN, Stimac D, Hechl P. Endoscope-assisted microsurgery for microvascular compression syndromes. Neurosurgery 2004; 54 (4) 876-881 ; discussion 881–883
- 25 Teo C, Nakaji P, Mobbs RJ. Endoscope-assisted microvascular decompression for trigeminal neuralgia: technical case report. Neurosurgery 2006; 59 (4) (Suppl. 02) E489-E490 ; discussion E490
- 26 Cutler AR, Kaloostian SW, Ishiyama A, Frazee JG. Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature. J Neurosurg 2012; 117 (3) 507-513
- 27 Wackym PA, King WA, Barker FG, Poe DS. Endoscope-assisted vestibular neurectomy. Laryngoscope 1998; 108 (12) 1787-1793
- 28 Schroeder HWS, Oertel J, Gaab MR. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle. J Neurosurg 2004; 101 (2) 227-232
- 29 Goksu N, Bayazit Y, Kemaloglu Y. Endoscopy of the posterior fossa and endoscopic dissection of acoustic neuroma. Neurosurg Focus 1999; 6 (4) e15
- 30 Magnan J, Chays A, Cohen JM, Caces F, Locatelli P. Endoscopy of the cerebellopontine angle. Rev Laryngol Otol Rhinol (Bord) 1995; 116 (2) 115-118
- 31 Wackym PA, King WA, Poe DS , et al. Adjunctive use of endoscopy during acoustic neuroma surgery. Laryngoscope 1999; 109 (8) 1193-1201
- 32 Pieper DR. The endoscopic approach to vestibular schwannomas and posterolateral skull base pathology. Otolaryngol Clin North Am 2012; 45 (2) 439-454 , x
- 33 de Divitiis O, Cavallo LM, Dal Fabbro M, Elefante A, Cappabianca P. Freehand dynamic endoscopic resection of an epidermoid tumor of the cerebellopontine angle: technical case report. Neurosurgery 2007; 61 (5) (Suppl. 02) E239-E240 ; discussion E240
- 34 Krass J, Hahn Y, Karami K, Babu S, Pieper DR. Endoscopic assisted resection of prepontine epidermoid cysts. J Neurol Surg A Cent E Neurosurg 2014; 75 (2) 120-125
- 35 Shahinian HK, Eby JB, Ocon M. Fully endoscopic excision of vestibular schwannomas. Minim Invasive Neurosurg 2004; 47 (6) 329-332
- 36 Shahinian HK, Ra Y. 527 fully endoscopic resections of vestibular schwannomas. Minim Invasive Neurosurg 2011; 54 (2) 61-67