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Intraoperative ultrasonography in microsurgical resection of vestibular schwannomas via retrosigmoid approach: surgical technique and proof-of-concept illustrative case series

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Abstract

Purpose

Intraoperative ultrasonography (ioUS) is an established tool for the real-time intraoperative orientation and resection control in intra-axial oncological neurosurgery. Conversely, reports about its implementation in the resection of vestibular schwannomas (VS) are scarce. The aim of this study is to describe the role of ioUS in microsurgical resection of VS.

Methods

ioUS (Craniotomy Transducer N13C5, BK5000, B Freq 8 MHz, BK Medical, Burlington, MA, USA) is integrated into the surgical workflow according to a 4-step protocol (transdural preresection, intradural debulking control, intradural resection control, transdural postclosure). Illustrative cases of patients undergoing VS resection through a retrosigmoid approach with the use of ioUS are showed to illustrate advantages and pitfalls of the technique.

Results

ioUS allows clear transdural identification of the VS and its relationships with surgically relevant structures of the posterior fossa and of the cerebellopontine cistern prior to dural opening. Intradural ioUS reliably estimates the extent of tumor debulking, thereby helping in the choice of the right moment to start peripheral preparation and in the optimization of the extent of resection in those cases where subtotal resection is the ultimate goal of surgery. Transdural postclosure ioUS accurately depicts surgical situs.

Conclusion

ioUS is a cost-effective, safe, and easy-to-use intraoperative adjunctive tool that can provide a significant assistance during VS surgery. It can potentially improve patient safety and reduce complication rates. Its efficacy on clinical outcomes, operative time, and complication rate should be validated in further studies.

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Data availability

The authors declare that the gathered data included and used for analysis outline are available in the manuscript.

Code availability

Not applicable.

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Funding

The authors declare that no funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Via Altura 3, 40139, Bologna, Italy

    Alessandro Carretta & Diego Mazzatenta

  2. Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland

    Alessandro Carretta, Stefanos Voglis, Niklaus Krayenbühl, Luca Regli & Carlo Serra

  3. Department of Otorhinolaryngology, University Hospital Zurich and University of Zurich, Zurich, Switzerland

    Christof Röösli & Alexander Huber

  4. Programma Neurochirurgia Ipofisi–Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy

    Diego Mazzatenta

  5. Division of Pediatric Neurosurgery, University Children’s Hospital, Zurich, Switzerland

    Niklaus Krayenbühl

Authors
  1. Alessandro Carretta
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  2. Stefanos Voglis
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  3. Christof Röösli
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  4. Diego Mazzatenta
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  5. Niklaus Krayenbühl
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  6. Alexander Huber
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  7. Luca Regli
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  8. Carlo Serra
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Contributions

Conceptualization: Alessandro Carretta, Carlo Serra; methodology: Alessandro Carretta, Carlo Serra; formal analysis and investigation: Alessandro Carretta, Stefanos Voglis; writing—original draft preparation: Alessandro Carretta, Stefanos Voglis, Carlo Serra; writing—review and editing: Christof Röösli, Diego Mazzatenta, Niklaus Krayenbühl, Alexander Huber, Luca Regli; resources: Christof Röösli, Niklaus Krayenbühl, Alexander Huber, Luca Regli, Carlo Serra; supervision: Carlo Serra.

Corresponding author

Correspondence to Alessandro Carretta.

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Ethics approval

Ethics committee approval for this specific study was waived because of its retrospective design. Surgical registry was approved upfront by the local ethics review board (Kantonale Ethikkommission KEK-ZH 2012–0244).

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Informed consent for this specific study was waived because of its retrospective design.

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Informed consent for publication was waived as included information is anonymized and the paper does not include images that may identify the patients.

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The authors declare no competing interests.

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Carretta, A., Voglis, S., Röösli, C. et al. Intraoperative ultrasonography in microsurgical resection of vestibular schwannomas via retrosigmoid approach: surgical technique and proof-of-concept illustrative case series. Acta Neurochir 166, 55 (2024). https://doi.org/10.1007/s00701-024-05962-x

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