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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 03): S276-S278
DOI: 10.1055/s-0038-1677488
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Endoscope-Assisted Minimally Invasive Microsurgical Removal of a Medium-Sized Acoustic Neuroma (T3a) through a Retrosigmoid Mini-Craniotomy with Preservation of Hearing

Peter Kurucz
1   Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
2   Department of Neurosurgery, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Bayern, Germany
,
Laszlo Barany
3   Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
,
Michael Buchfelder
2   Department of Neurosurgery, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Bayern, Germany
,
Oliver Ganslandt
1   Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany
› Author Affiliations
Further Information

Address for correspondence

Peter Kurucz, MD
Department of Neurosurgery, Klinikum Stuttgart
Kriegsbergstrasse 60, Stuttgart 70174
Germany   

Publication History

22 April 2018

11 November 2018

Publication Date:
18 February 2019 (online)

 
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    Abstract

    A 45-year-old male patient with reduced hearing in the right ear was diagnosed with a medium-sized (T3a) acoustic neuroma. The operation was performed through an individually tailored retrosigmoid mini-craniotomy. Endoscope-assisted microsurgical technique was applied to early detect the location of the facial and cochlear nerves as well as to look around the hidden corners during the surgery. The entire operation was performed without using brain retractors. The moderate intrameatal extension of the tumor and the use of angled endoscopes allowed to avoid the drilling of the internal auditory meatus. The lesion could be completely removed and the patient showed a satisfactory hearing recovery in the follow-up examinations 3 months after the surgery.

    The link to the video can be found at: https://youtu.be/dAYLakih924.


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    Keywords

    acoustic neuroma - endoscope-assisted microsurgery - minimally invasive - keyhole approach - retrosigmoid craniotomy
    Zoom Image
    Fig. 1 Pre- and Postoperative MRI images. Preoperative CISS (A) and contrast-agent enhanced T1-weighted (B) MRI-scans showed a medium-sized (T3a) acoustic neuroma on the right side with slightly protrusion into the internal auditory canal. The cerebellopontine angle is filled by the tumor and the surface of the brainstem is in a gently contact with the lesion. The postoperative CISS (C) and contrast-agent enhanced T1-weighted (D) MRI-scans 3 months after the surgery verified the complete tumor removal.
    Zoom Image
    Fig. 2 Intraoperative photomicrographs. (A) Microscopic view of the tumor through the retrosigmoid mini-craniotomy. (B) Overview of the tumor and the surrounding anatomical structures through the 30 degree endoscope. (C) Detection of the cochlear and facial nerves with a 30 degree endoscope prior to the tumor resection. (D) Microscopic view of the operative field with the intact cochlear and facial nerves after complete resection of the tumor. AICA, anterior inferior cerebellar artery; AN, acoustic neuroma; IAM, internal auditory meatus; nV, trigeminal nerve; nVII, facial nerve; nVIII, cochlear nerve; petr. v., superior petrosal vein; tent, tentorium.

    www.thieme.com/skullbasevideos

    www.thieme.com/jnlsbvideos


    Quality:

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    Conflict of Interest

    None declared.

    Address for correspondence

    Peter Kurucz, MD
    Department of Neurosurgery, Klinikum Stuttgart
    Kriegsbergstrasse 60, Stuttgart 70174
    Germany   

       Permissions and Reprints
    Zoom Image
    Fig. 1 Pre- and Postoperative MRI images. Preoperative CISS (A) and contrast-agent enhanced T1-weighted (B) MRI-scans showed a medium-sized (T3a) acoustic neuroma on the right side with slightly protrusion into the internal auditory canal. The cerebellopontine angle is filled by the tumor and the surface of the brainstem is in a gently contact with the lesion. The postoperative CISS (C) and contrast-agent enhanced T1-weighted (D) MRI-scans 3 months after the surgery verified the complete tumor removal.
    Zoom Image
    Fig. 2 Intraoperative photomicrographs. (A) Microscopic view of the tumor through the retrosigmoid mini-craniotomy. (B) Overview of the tumor and the surrounding anatomical structures through the 30 degree endoscope. (C) Detection of the cochlear and facial nerves with a 30 degree endoscope prior to the tumor resection. (D) Microscopic view of the operative field with the intact cochlear and facial nerves after complete resection of the tumor. AICA, anterior inferior cerebellar artery; AN, acoustic neuroma; IAM, internal auditory meatus; nV, trigeminal nerve; nVII, facial nerve; nVIII, cochlear nerve; petr. v., superior petrosal vein; tent, tentorium.