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. 2015 Jun;76(3):230-8.
doi: 10.1055/s-0034-1543974. Epub 2015 Jan 21.

Endoscopic Resection of Vestibular Schwannomas

Pradeep Setty  1 , Kenneth P D'Andrea  1 , Emily Z Stucken  2 , Seilesh Babu  2 , Michael J LaRouere  2 , Daniel R Pieper  3
Affiliations

Endoscopic Resection of Vestibular Schwannomas

Pradeep Setty et al. J Neurol Surg B Skull Base. 2015 Jun.

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.

Keywords: acoustic neuroma; cerebellopontine angle; endoscopy; skull base; vestibular schwannoma.

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Figures

Fig. 1
Fig. 1
Polyaxial pneumatic holding arm.
Fig. 2
Fig. 2
Preoperative setup with the patient in the appropriate position. The holding arm is mounted to the bed on the contralateral side, and the high-definition monitor is directly behind it.
Fig. 3
Fig. 3
Preoperative view of skin markings prior to incision. Posteriorly, the external occipital protuberance has been marked with a horizontal line. The estimated location of the sigmoid sinus has also been marked with a crossing line that delineates the patient's hairline. Anteriorly, the root of the zygoma has been marked with a horizontal line.
Fig. 4
Fig. 4
Intraoperative view of the size of the retrosigmoid craniotomy. A U.S. quarter is placed just above the incision for reference size.
Fig. 5
Fig. 5
View of dural closure with dural onlay graft.
Fig. 6
Fig. 6
View of craniectomy defect filled in with hydroxyapatite bone cement.
Fig. 7
Fig. 7
Operative setup with the holding arm arching over the patient and rigidly holding the endoscope in place. Note how the surgeon is able to operate with bimanual dexterity while still maintaining optimal visualization.
Fig. 8
Fig. 8
Pistol-gripped bipolar that has replaced the bayonet-style traditional bipolar.
See this image and copyright information in PMC

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