Abstract
We present a case of a mid-sized vestibular schwannoma (T3b according to the Hannover
classification) that was resected through a retrosigmoid transmeatal approach in semi-sitting
position under endoscopic assistance. The patient is a 52-year-old male with acute
loss of functional hearing on the right side. Audiometry confirmed a loss of up to
60 dB and lost speech discrimination, there were no associated symptoms such as tinnitus
or vertigo. This 2D video demonstrates positioning, OR set-up, anatomical and surgical
nuances of the skull base approach and the operative technique for microdissection
of the tumor from the critical neurovascular structures, especially the facial and
cochlear nerves. A gross total resection was achieved and the patient discharged home
after four days with unaltered function of the facial nerve (HB I). At one year follow
up there was no indication of residual or recurrence.
In summary, the retrosigmoid transmeatal approach is an important and powerful tool
in the armamentarium for the microsurgical management of all kinds of vestibular schwannomas.
Provided the necessary anesthesiological precautions and intraoperative procedures
the semi-sitting position is safe and effective. If needed, the approach can be complemented
by the use of an endoscope for visualization of the distal internal auditory canal.
The link to the video can be found at: https://youtu.be/pPKT4_5nIn0.
Keywords
retrosigmoid transmeatal approach - endoscope-assisted approach - vestibular schwannoma
- semi-sitting position - Tuebingen line
