Abstract
Background
To improve hearing function after resection of large vestibular schwannomas, we describe a strategy of vestibular-nerve-fiber preservation. Anatomical considerations and stepwise dissection are described.
Method
Steps include locating the vestibular nerve at the brainstem and identifying a dissection plane between nerve fibers and tumor capsule. Using this plane to mobilize and resect tumor reduced manipulation and maintained vascularity of underlying cochlear and facial nerves.
Conclusion
Preservation of hearing function is feasible in large vestibular schwannomas with vestibular-nerve-fiber preservation. Reducing manipulation and ischemic injury of underlying cochlear and facial nerves thereby helped facilitate hearing preservation, even in large tumors.
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Not applicable. This submission is of a operative case; no data was utilized in the production of this manuscript.
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References
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Conception and design: OK, EAH, ASY. Drafting the article: OK, EAH, RA, ASY (all authors). Critically revising the article: OK, EAH, RA, ASY (all authors). Reviewed submitted version of manuscript: OK, EAH, RA, ASY (all authors).
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Key Points
• Identification of the vestibular nerve at the brainstem and preservation of its integrity are crucial first steps. The presence of prominent vasculature on the inferomedial portion of the tumor is suggestive that the vestibular nerve is nearby.
• The plane between vestibular nerve and tumor is initially established through sharp dissection at the brain stem.
• The tumor capsule is dissected from medial to lateral while maintaining the integrity of the underlying vestibular fibers which serve as a buffer to protect the underlying cochlear nerve from manipulation.
• The plane of dissection that initially mobilized tumor in the cisternal portion is now used for its mobilization out of the IAC. Meticulous, atraumatic dissection helps maintain the integrity of the underlying vestibulocochlear nerve.
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Khanna, O., Hogan, E., Alvarez, R. et al. How I do it: hearing preservation in large vestibular schwannomas using vestibular nerve fiber preservation technique. Acta Neurochir 166, 105 (2024). https://doi.org/10.1007/s00701-024-05998-z
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DOI: https://doi.org/10.1007/s00701-024-05998-z