CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 05): S385-S386
DOI: 10.1055/s-0038-1669985
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Retrosigmoid Transmeatal Endoscope-Assisted Approach in Semi-Sitting Position for Resection of Vestibular Schwannoma: 2-D operative Video

Rocio Evangelista-Zamora
1  Department of Neurological Surgery, Eberhard-Karls University, University Hospital Tübingen, Tübingen, Germany
,
Stefan Lieber
1  Department of Neurological Surgery, Eberhard-Karls University, University Hospital Tübingen, Tübingen, Germany
2  Department of Neurological Surgery, Microsurgical Neuroanatomy Lab, University of Pittsburgh, Pennsylvania, United States
,
Florian H. Ebner
1  Department of Neurological Surgery, Eberhard-Karls University, University Hospital Tübingen, Tübingen, Germany
,
Marcos Tatagiba
1  Department of Neurological Surgery, Eberhard-Karls University, University Hospital Tübingen, Tübingen, Germany
› Author Affiliations
Further Information

Publication History

05 June 2018

11 August 2018

Publication Date:
09 October 2018 (eFirst)

  

Abstract

We present a case of a mid-sized vestibular schwannoma (T3b according to the Hannover classification) that was resected through a retrosigmoid transmeatal approach in semi-sitting position under endoscopic assistance. The patient is a 52-year-old male with acute loss of functional hearing on the right side. Audiometry confirmed a loss of up to 60 dB and lost speech discrimination, there were no associated symptoms such as tinnitus or vertigo. This 2D video demonstrates positioning, OR set-up, anatomical and surgical nuances of the skull base approach and the operative technique for microdissection of the tumor from the critical neurovascular structures, especially the facial and cochlear nerves. A gross total resection was achieved and the patient discharged home after four days with unaltered function of the facial nerve (HB I). At one year follow up there was no indication of residual or recurrence.

In summary, the retrosigmoid transmeatal approach is an important and powerful tool in the armamentarium for the microsurgical management of all kinds of vestibular schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semi-sitting position is safe and effective. If needed, the approach can be complemented by the use of an endoscope for visualization of the distal internal auditory canal.

The link to the video can be found at: https://youtu.be/pPKT4_5nIn0.

Disclosures

None; the authors have no personal, institutional, or financial interest in any of the materials, drugs, or devices described in this article.