Flexible Endoscope for IAC Control of Tumor Removal
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Using a retrosigmoid approach, the internal auditory meatus cannot be completely opened to expose the fundus in order to preserve the superior and posterior semicircular canals. Therefore, a straight microscopic view cannot provide an adequate visualization of the most lateral part of the internal auditory canal (IAC). Endoscope assistance provides optimal exposure of the fundus of the IAC and improves the ability to evaluate the extent of resection intraoperatively. Our group reported the successful surgical treatment (total resection) of three cases of intracanalicular vestibular schwannomas operated on with an endoscopic-assisted retrosigmoid approach by means of a flexible endoscope (4-mm × 65-cm, Karl Storz, Inc.). The main advantage of the flexible endoscope is the possibility to orient the endoscopic tip directly into the IAC to obtain an optimal visualization of the fundus. As opposed to rigid devices, the flexible endoscope has to be manipulated with two hands. However, this limitation can be easily overcome through good cooperation and synchronicity between the operator and the assistant.
KeywordsVestibular schwannoma/retrosigmoid approach Vestibular schwannoma/endoscope Vestibular schwannoma/surgery
- 2.Nonaka Y, Fukushima T, Watanabe K, Friedman AH, Sampson JH, Mcelveen JT, et al. Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery. 2013;72(2 Suppl Operative):ons103–15; discussion ons15.PubMedPubMedCentralGoogle Scholar
- 6.Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American Academy of Otolaryngology-Head and Neck Surgery Foundation, INC. Otolaryngol Head Neck Surg. 1995;113(3):179–80.Google Scholar
- 8.Mazzoni A, Zanoletti E, Denaro L, Martini A, Avella D. Retrolabyrinthine meatotomy as part of retrosigmoid approach to expose the whole internal auditory canal: rationale, technique, and outcome in hearing preservation surgery for vestibular schwannoma. Oper Neurosurg (Hagerstown). 2018;14(1):36–44.CrossRefGoogle Scholar
- 9.Pillai P, Sammet S, Ammirati M. Image-guided, endoscopic-assisted drilling and exposure of the whole length of the internal auditory canal and its fundus with preservation of the integrity of the labyrinth using a retrosigmoid approach: a laboratory investigation. Neurosurgery. 2009;65(6 Suppl):53–9; discussion 9.PubMedGoogle Scholar