Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment

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OBJECTIVE

The aim of this study was to describe the first case series in which an exclusive endoscopic transcanal transpromontorial approach (EETTA) was used to treat small vestibular schwannomas (VSs) and meningiomas of the internal auditory canal (IAC).

METHODS

The authors performed a retrospective review of patients who had undergone surgery using an EETTA to the IAC at 2 university tertiary care referral centers during the period from November 2011 to January 2015.

RESULTS

Ten patients underwent surgery via an EETTA for the treatment of VS in the IAC at the University Hospital of Modena or the University Hospital of Verona. The patients had Koos Grade I or II tumors and American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Class D hearing status preoperatively. Gross-total resection was achieved in all patients. No major complications such as cerebrospinal fluid leakage or hemorrhage were reported. In 7 of 10 (70%) patients, facial nerve function was normal immediately after surgery (Rough Grading System [RGS] Grade I). Two patients presented with a transitory facial palsy immediately after surgery (RGS Grade II–III) but experienced complete recovery during the follow-up period. The mean follow-up was 10 months.

CONCLUSIONS

The EETTA proved to be successful for the removal of VS or meningioma involving the cochlea, fundus, and IAC, with possible lower complication rates and less invasive procedures than those for traditional microscopic approaches. The potential for the extensive and routine use of this approach in lateral and posterior skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among the otolaryngological and neurosurgical communities.

ABBREVIATIONSAAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; CPA = cerebellopontine angle; CS = cochlear schwannoma; CSF = cerebrospinal fluid; EAC = external auditory canal; EETTA = exclusive endoscopic transcanal transpromontorial approach; IAC = internal auditory canal; ICU = intensive care unit; RGS = Rough Grading System; VS = vestibular schwannoma.
Article Information

Contributor Notes

INCLUDE WHEN CITING Published online March 11, 2016; DOI: 10.3171/2015.11.JNS15952.Correspondence Matteo Alicandri-Ciufelli, Department of Otolaryngology, University Hospital of Modena, Via del Pozzo 71, Modena 41100, Italy. email: matteo.alicandri@hotmail.it.

© AANS, except where prohibited by US copyright law.

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