Vestibular schwannoma surgery

• Clinical outcomes and safety of large or giant vestibular schwannoma in older patients undergoing microsurgery: a matched cohort study
• Ondine's curse: clinical presentation with diaphragmatic pacing and spontaneous respiratory recovery. Illustrative case
• Intraoperative Neuromonitoring in Vestibular Schwannoma Surgery
• The genetic landscape and possible therapeutics of neurofibromatosis type 2
• Surgical outcomes in large vestibular schwannomas: should cerebellopontine edema be considered in the grading systems?
• Does vestibular function correlate with objective MRI findings after vestibular schwannoma surgery?
• The Effect of Immediate Microsurgical Resection of Vestibular Schwannoma on Hearing Preservation
• Mastering the Trans-Labrynthine Approach to Internal Acoustic Meatus: A Cadaveric Temporal Bone Study

Facial nerve preservation and hearing preservation have been achieved by significant advances in skull base microsurgical techniques and intraoperative neuromonitoring. Diffusion tensor imaging is a powerful and accurate method for preoperatively identifying the facial nerve in relation to vestibular schwannomas. Endoscopy offers excellent illumination of the anatomical structures and provides panoramic vision inside the surgical area ¹⁾.

The goal of microsurgical removal of a vestibular schwannoma is to completely remove the tumor, to provide long-term durable cure. In many cases, less than gross total resection (GTR) is performed to preserve neurological, and especially facial nerve function.

In selected cases, hearing preservation.

In modern neurosurgery Madjid Samii is considered to be one of the leading experts in vestibular schwannoma surgery.

Vestibular schwannoma microsurgery via the suboccipital approach with the help of intraoperative brainstem auditory evoked potentials is a common treatment option ²⁾.

The procedure is performed under general anesthesia with cranial nerve monitoring.

Following suboccipital craniotomy craniectomy, durotomy, CSF release from the foramen magnum, and identification of cranial nerve position, the tumor is debulked internally. The internal auditory canal is drilled and dissection of the tumor progresses. Following resection, the IAC is waxed and a fat graft placed. A Water-tight pericranial graft is sewn in and a titanium mesh cranioplastyplaced. The muscle and skin are closed in layers. The video can be found here: http://youtu.be/ialtKy3cuPU ³⁾.

Recent advances in electrophysiological technology have considerably contributed to improvement in functional outcome of vestibular schwannoma surgery in terms of hearing preservation and facial nerve paresis. Perioperative intravenous nimodipine and hydroxyethyl starch may be valuable additions to surgery ⁴⁾.

The endoscope may be useful, especially in surgical techniques where there is poor control of the internal auditory canal (IAC). An endoscopic support technique is strongly recommended to avoid residual disease, particularly in retrosigmoid and retrolabyrinthine approaches. Moreover, the recent introduction of the transcanal transpromontorial approach allows the endoscope to be used during all the procedures in patients affected by a vestibular schwannoma limited to the IAC or to support surgical procedures during an enlarged microscopic approach ⁵⁾.

Vestibular schwannoma subtotal resection.

see Vestibular schwannoma approaches.

see Vestibular schwannoma surgery complications

see Vestibular schwannoma surgery outcome