J Neurol Surg B Skull Base 2023; 84(S 01): S1-S344
DOI: 10.1055/s-0043-1762342
Presentation Abstracts
Poster Abstracts

Transcanal Transpromontorial Approach in Skull Base Surgery: A Systematic Review of the Indications, Operative Techniques, and Treatment Outcomes

Paolo Palmisciano
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Edward J. Doyle
2   Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Samer S. Hoz
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Daryn Cass
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Ravi N. Samy
2   Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Norberto Andaluz
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Mario Zuccarello
1   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Background: Surgical access to the internal auditory canal (IAC) can be highly invasive. Exclusive endoscopic (EETTA) and expanded (ExpTTA) transcanal transpromontorial approaches have shown promising results.

Objective: To systematically review the literature on EETTA and ExpTTA.

Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched to include studies reporting EETTA or ExpTTA in skull base surgery. Indications, techniques, and outcomes were analyzed.

Results: We included 16 studies comprising 173 patients. All patients had non-serviceable hearing; a significant proportion complained of intractable vertigo (22%) and/or tinnitus (20.8%). Baseline facial nerve function was mostly House-Brackmann grade-I (96.5%). Most lesions were vestibular/cochlear schwannomas (98.3%), mainly of KOOS grade-I (45.9%) or II (47.1%). EETTA was performed in 101 patients (58.4%) and ExpTTA in 72 (41.6%), achieving gross-total resection in all cases. Surgical indications were: non-serviceable hearing, KOOS grade I–III, intractable vertigo or tinnitus. Median duration of surgery was 198.5 minutes (range, 128–360) and median hospital stay 7 days (range, 2–10). Transient complications occurred in 30 patients (17.3%): facial nerve palsy with spontaneous resolution (10.4%), and cerebrospinal fluid leaks (1.9%) or suture dehiscence (1.7%) requiring surgical revision. Persistent complications occurred in 34 patients (19.6%): persistent facial nerve palsy in 22 (12.7%) and persistent vertigo in 12 (6.9%). Median follow-up was 12 months (range, 1–69). Postsurgery facial nerve function was stable in 134 patients (77.4%), worsened in 38 (22%), and improved in 1 (0.6%).[1] [2]

Conclusion: Transpromontorial approaches offer newer routes for IAC surgery, but their restricted indications and unfavorable facial outcomes currently limit their use compared with traditional lateral skull base approaches.



Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2023

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  • References

  • 1 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
    PubMed
  • 2 Marchioni D, Carner M, Soloperto D, et al. Expanded transcanal transpromontorial approach: a novel surgical technique for cerebellopontine angle vestibular schwannoma removal. Otolaryngol Head Neck Surg 2018;158(4):710–715
    PubMed