Microsurgical Resection of Intracanalicular Vestibular Schwannoma via Retrosigmoid Approach: 3-Dimensional Operative Video

Vestibular schwannomas are a multifaceted group of tumors that can present with different sizes and involvement of critical neurovascular structures.1-6 While operating on these tumors, a critical goal is postoperative preservation of facial nerve function and hearing. We present the case of a 66-ye...

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Published inWorld neurosurgery Vol. 157; p. 1
Main Authors Ceccato, Guilherme H.W., de Oliveira, Júlia S., Neto, Pedro H.S., de Carvalho, Nick D., Coelho, Vinícius N., Hasegawa, Hugo A., Sufianov, Albert A., Borba, Luis A.B.
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.01.2022
Subjects
Aged
Craniotomy - methods
Humans
Intracanalicular
Intraoperative Neurophysiological Monitoring
Male
Microsurgery - methods
Neuroma, Acoustic - surgery
Neurosurgical Procedures - methods
Petrous Bone - surgery
Retrosigmoid
Semicircular Canals - surgery
Treatment Outcome
Tumor
Vestibular schwannoma
Intracanalicular
Tumor
Retrosigmoid
Vestibular schwannoma
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Summary:Vestibular schwannomas are a multifaceted group of tumors that can present with different sizes and involvement of critical neurovascular structures.1-6 While operating on these tumors, a critical goal is postoperative preservation of facial nerve function and hearing. We present the case of a 66-year-old male with a history of severe left-sided tinnitus and progressive hearing loss (Video 1). Preoperative imaging depicted a lesion highly suggestive of an intracanalicular vestibular schwannoma. Due to worsening of symptoms and after thoughtful discussion with the patient, microsurgical resection was indicated under constant neurophysiologic monitoring. A retrosigmoid approach was employed, and the posterior wall of the internal auditory canal was opened, allowing exposure of tumor and its total resection. Postoperative imaging demonstrated complete tumor resection. The patient's symptoms improve, and there were no new neurologic deficits on follow-up. Anatomical images were a Courtesy of the Rhoton Collection, American Association of Neurological Surgeons (AANS)/Neurosurgical Research and Education Foundation (NREF).
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2021.09.112