The Feasibility of a Modified Exclusive Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannomas

Abstract

Objective We evaluated the feasibility of an exclusive endoscopic transcanal transpromontorial approach (EETTA) for the treatment of small vestibular schwannomas (VSs) limited to the internal auditory canal (IAC), and introduced a modification without external auditory canal closure.

Methods Between June 2016 and June 2017, seven patients with VS underwent surgery using a modified EETTA. Treatment outcomes, including efficacy of tumor resection, preservation of function, operation time, and quality of life (QOL), were evaluated.

Results The patients preoperatively exhibited Koos Grade I/II tumors and severe-to-profound hearing loss. Gross total resection was accomplished in all cases. There were no major complications, and all patients exhibited normal facial nerve function immediately after surgery. The mean follow-up period was 12.9 months. The operation time (average 196.3 ± 64.9 minutes) and hospitalization period (average 7.4 ± 1.0 days) were favorable. Short Form-36 scores for QOL showed unremarkable results compared with previous reports.

Conclusions The modified EETTA was effective in the removal of VSs in the IAC. It can be an alternative surgical option for small VSs.

Keywords

endoscopy - ear canal - cochlea - acoustic neuroma

• References

• 1 Kennedy RJ, Shelton C, Salzman KL, Davidson HC, Harnsberger HR. Intralabyrinthine schwannomas: diagnosis, management, and a new classification system. Otol Neurotol 2004; 25 (02) 160-167
• 2 Meyer TA, Canty PA, Wilkinson EP, Hansen MR, Rubinstein JT, Gantz BJ. Small acoustic neuromas: surgical outcomes versus observation or radiation. Otol Neurotol 2006; 27 (03) 380-392
• 3 Neff BA, Willcox Jr TO, Sataloff RT. Intralabyrinthine schwannomas. Otol Neurotol 2003; 24 (02) 299-307
• 4 Thakur JD, Banerjee AD, Khan IS. , et al. An update on unilateral sporadic small vestibular schwannoma. Neurosurg Focus 2012; 33 (03) E1
• 5 Falcioni M, Taibah A, Di Trapani G, Khrais T, Sanna M. Inner ear extension of vestibular schwannomas. Laryngoscope 2003; 113 (09) 1605-1608
• 6 Mohr G, Sade B, Dufour J-J, Rappaport JM. Preservation of hearing in patients undergoing microsurgery for vestibular schwannoma: degree of meatal filling. J Neurosurg 2005; 102 (01) 1-5
• 7 Arriaga MA, Lin J. Translabyrinthine approach: indications, techniques, and results. Otolaryngol Clin North Am 2012; 45 (02) 399-415 , ix
• 8 Irving RM, Jackler RK, Pitts LH. Hearing preservation in patients undergoing vestibular schwannoma surgery: comparison of middle fossa and retrosigmoid approaches. J Neurosurg 1998; 88 (05) 840-845
• 9 Marchioni D, Alicandri-Ciufelli M, Rubini A, Masotto B, Pavesi G, Presutti L. Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment. J Neurosurg 2017; 126 (01) 98-105
• 10 Koos W, Speltzer Reds. Microsurgery of cerebellopontine angle tumors In: Clinical Microneurosurgery. Stuttgart: Thieme; 1976
• 11 da Cruz MJ, Moffat DA, Hardy DG. Postoperative quality of life in vestibular schwannoma patients measured by the SF36 Health Questionnaire. Laryngoscope 2000; 110 (01) 151-155
• 12 Myrseth E, Møller P, Pedersen P-H, Lund-Johansen M. Vestibular schwannoma: surgery or gamma knife radiosurgery? A prospective, nonrandomized study. Neurosurgery 2009; 64 (04) 654-661 , discussion 661–663
• 13 Marchioni D, Carner M, Rubini A. , et al. The fully endoscopic acoustic neuroma surgery. Otolaryngol Clin North Am 2016; 49 (05) 1227-1236
• 14 Presutti L, Alicandri-Ciufelli M, Cigarini E, Marchioni D. Cochlear schwannoma removed through the external auditory canal by a transcanal exclusive endoscopic technique. Laryngoscope 2013; 123 (11) 2862-2867
• 15 Bennett M, Haynes DS. Surgical approaches and complications in the removal of vestibular schwannomas. Otolaryngol Clin North Am 2007; 40 (03) 589-609 , ix–x
• 16 Charabi S, Thomsen J, Mantoni M. , et al. Acoustic neuroma (vestibular schwannoma): growth and surgical and nonsurgical consequences of the wait-and-see policy. Otolaryngol Head Neck Surg 1995; 113 (01) 5-14
• 17 Di Lella F, Dispenza F, De Stefano A, Falcioni M, Sanna M. Management of intralabyrinthine schwannomas. Auris Nasus Larynx 2007; 34 (04) 459-463
• 18 Perez R, Chen JM, Nedzelski JM. Intratemporal facial nerve schwannoma: a management dilemma. Otol Neurotol 2005; 26 (01) 121-126
• 19 Stangerup S-E, Thomsen J, Tos M, Cayé-Thomasen P. Long-term hearing preservation in vestibular schwannoma. Otol Neurotol 2010; 31 (02) 271-275
• 20 Gosselin É, Maniakas A, Saliba I. Meta-analysis on the clinical outcomes in patients with intralabyrinthine schwannomas: conservative management vs. microsurgery. Eur Arch Otorhinolaryngol 2016; 273 (06) 1357-1367
• 21 Kim HJ, Jin Roh K, Oh HS, Chang WS, Moon IS. Quality of life in patients with vestibular schwannomas according to management strategy. Otol Neurotol 2015; 36 (10) 1725-1729
• 22 Miller RS, Pensak ML. An anatomic and radiologic evaluation of access to the lateral internal auditory canal via the retrosigmoid approach and description of an internal labyrinthectomy. Otol Neurotol 2006; 27 (05) 697-704
• 23 Colletti V, Fiorino F. Is the middle fossa approach the treatment of choice for intracanalicular vestibular schwannoma?. Otolaryngol Head Neck Surg 2005; 132 (03) 459-466
• 24 Colletti V, Fiorino F. Middle fossa versus retrosigmoid-transmeatal approach in vestibular schwannoma surgery: a prospective study. Otol Neurotol 2003; 24 (06) 927-934
• 25 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 1997; 40 (01) 11-21 , discussion 21–23
• 26 Sanna M, Taibah A, Russo A, Falcioni M, Agarwal M. Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery. Otol Neurotol 2004; 25 (03) 379-386