Technology-Assisted Minimally Invasive Surgical Options for the Treatment of Medium to Large Vestibular Schwannomas: Our Experience

Introduction: Treatment of vestibular schwannomas presents many controversial aspects, from the indication to the selection of the best treatment option. In the era of stereotactic radiotherapy, microsurgery has to be competitive in terms of providing the best chances of functional preservation and complete tumor removal. The two most commonly used surgical approaches are the retrosigmoid suboccipital and the presigmoid translabyrinthine. We describe our experience regarding the endoscopy-assisted presigmoid retrolabyrinthine approach (EAPRA) and the recent use of the exoscope in the pre-sigmoid and translabyrinthine approaches.

Methods: From May 2009 to June 2020, a total of 27 patients affected from large sporadic vestibular schwannomas were surgically treated in our department. The EAPRA was used in 23 patients. Exoscope-assisted trans-labyrinthine approach was used in 2 cases and exoscope-assisted presigmoid approach was used in the remaining two patients.

Results: In the EAPRA group, a complete tumor removal was obtained in 20 out of 23 patients. Postoperative transient facial nerve function impairment or worsening was observed in three cases, and hearing deterioration in two patients. No threatening complications occurred after surgery, and the length of hospitalization was usually less than 10 days. In the four patients treated by using the exoscope a complete resection of the schwannoma was obtained, without any complications.

Conclusions: The EAPRA can provide direct access to the cerebello-pontine angle along with labyrinthine complex preservation, conserving hearing function and allowing minimal cerebellar retraction. Endoscopic assistance is a crucial adjunct in the presigmoid retrolabyrinthine approach in order to overcome the limits imposed by labyrinthine complex preservation. It ensures complete visualization of the intracanalicular portion of the schwannoma, thus improving the rate of a radical tumor resection. The EAPRA could represent a valid surgical option in vestibular schwannoma surgery. In our preliminary experience, also the use of the exoscope can help a good visualization of the surgical field, allowing a safe and complete resection.

Publication History

Article published online:
12 February 2021