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Mario Sanna - One of the best experts on this subject based on the ideXlab platform.
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facial nerve outcomes following total excision of vestibular schwannoma by the enlarged Translabyrinthine Approach
Otology & Neurotology, 2019Co-Authors: Manjunath Dandinarasaiah, Enrico Piccirillo, Sampath Chandra Prasad, Ashish Vashishth, Mastronardi Valentina, Golda Grinblat, Corneliu Mircea Codreanu, Mario SannaAbstract:OBJECTIVE: To study the early and late facial nerve (FN) outcomes in different tumor classes in addition to determining the predictive factors for the same. STUDY DESIGN: A retrospective clinical study. SETTING: A quaternary referral otology and skull base center. PATIENTS AND METHODS: A retrospective study of 1983 cases of vestibular schwannomas (VSs) with preoperative normal FN function, undergoing total excision with anatomical preservation of the nerve by enlarged Translabyrinthine Approach (ETLA) were included. FN status was recorded postoperatively at day 1, at discharge, and at 1-year follow-up and were analyzed in different tumor sizes. RESULTS: At 1 year, 988 patients with House-Brackmann (H-B) grade I and II FN at day 1 after surgery, 958 (96.9%) maintained their status up-to 1 year. Of the 216 patients with H-B grade III at day 1 after surgery, 113 (52.3%) improved to H-B grade I and II. Similarly, of the 779 patients with H-B grade IV and VI FN function at day 1 after surgery, improvement to H-B III and H-B I and II were noted in 442 (56.7%) and 80 (10.3%) of patients, respectively. Intrameatal and extrameatal tumors upto 2 cm showed better recovery from H-B grade III to H-B I and II and from H-B grade IV and VI to H-B I and III when compared with extrameatal tumors >2 cm (p = 0.001). CONCLUSION: Tumors of smaller sizes have good immediate postoperative FN results and recover well at the end of 1 year while more than 3 cm have poor outcomes and recover poorly at the end of 1 year. When the VSs reaches more than 1 cm, the HB I and II outcomes drop significantly.
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Vestibular Schwannoma Resection with Ipsilateral Simultaneous Cochlear Implantation in Patients with Normal Contralateral Hearing.
Audiology and Neuro-otology, 2016Co-Authors: Mario Sanna, Maria Del Mar Medina, Aldin Macak, Gianluca Rossi, Valerio Sozzi, Sampath Chandra PrasadAbstract:Objective: To report the hearing results of cochlear implantation simultaneous to vestibular schwannoma (VS) resection by means of a Translabyrinthine Approach in
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Surgical results and technical refinements in Translabyrinthine excision of vestibular schwannomas: the Gruppo Otologico experience.
Neurosurgery, 2012Co-Authors: Mehdi Ben Ammar, Abdelkader Taibah, Enrico Piccirillo, Vedat Topsakal, Mario SannaAbstract:BACKGROUND: Vestibular schwannomas (VSs) are the most common cerebellopontine angle tumors, accounting for 75% of all lesions in this location. OBJECTIVE: To evaluate the results after removal of VS through the enlarged Translabyrinthine Approach, which is a widening of the classic Translabyrinthine Approach that gives larger access and provides more room to facilitate tumor removal and to minimize surgery-related morbidities. METHODS: This was a retrospective study of 1865 patients who underwent VS excision through the enlarged Translabyrinthine Approach between 1987 and 2009. Mean age was 50.39 years. Mean tumor size was 1.8 cm. Median follow-up was 5.7 years. RESULTS: Total removal was achieved in 92.33% of cases; 143 patients had incomplete resection with evidence of regrowth in 8. In the 1742 previously untreated patients, anatomic preservation of facial nerve was achieved in 1661 cases (95.35%), and House-Brackmann grade I or II was reached in 1047 patients (59.87%). Facial nerve outcome was significantly better in tumors ≤ 20 mm. Surgical complications included cerebrospinal fluid leakage in 0.85%, meningitis in 0.10%, intracranial bleeding in 0.80%, non--VII/VIII cranial nerve palsy in 0.96%, cerebellar ataxia in 0.69%, and death in 0.10%. The technical modifications that evolved with increasing experience are described. CONCLUSION: The enlarged Translabyrinthine Approach is a safe and effective Approach for the removal of VS. In our experience, the complication rate is very low and tumor size is still the main factor influencing postoperative facial nerve function with a cutoff point at around 20 mm.
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enlarged Translabyrinthine Approach with transapical extension in the management of giant vestibular schwannomas personal experience and review of literature
Otology & Neurotology, 2011Co-Authors: Roberto D Angeli, Enrico Piccirillo, Abdelkader Taibah, Giuseppe Di Trapani, Giuliano Sequino, Mario SannaAbstract:OBJECTIVE: To describe and analyze the main outcomes achieved in a series of patients with sporadic vestibular schwannoma (VS) larger than 40 mm in extrameatal diameter, defined as giant VS, submitted to microsurgery by the enlarged Translabyrinthine Approach with transapical extension. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: A retrospective chart review was conducted on 2,133 patients who underwent surgery for VS from April 1987 to July 2009. One hundred ten cases of giant VS were elected for analysis. MAIN OUTCOME MEASURES: Extent of removal, residual or recurrent disease, facial nerve integrity during surgery, long-term facial nerve function, and postoperative complications. RESULTS: Total removal was accomplished in 91.8% of cases. In 5 patients (4.5%), total removal was accomplished in 2 stages. Near-total removal was performed in 7 patients (6.3%). The facial nerve was anatomically preserved in 76.4% of cases. Intraoperative facial nerve reconstruction was performed in 8 cases. Facial nerve function after 1 year of follow-up was House-Brackmann grades I to III in 75% of cases. There were no deaths in this series. Neurovascular life-threatening complications occurred in 2 patients. Cerebrospinal fluid leak was present in 1.8% of cases. CONCLUSION: Results indicate the enlarged Translabyrinthine Approach with transapical extension as an elective Approach for removal of giant VS. The method permits achievement of a high rate of total removal with low incidence of complications.
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Cerebrospinal Fluid Leak Prevention After Translabyrinthine Removal of Vestibular Schwannoma
Laryngoscope, 2004Co-Authors: Tarek Khrais, Abdelkader Taibah, Maurizio Falcioni, Manoj Agarwal, Mario SannaAbstract:Objectives/Hypothesis: The purpose of the report was to present an update on the authors' results for prevention and management of cerebrospinal fluid (CSF) leak after Translabyrinthine Approach for vestibular schwannoma. Study Design: Retrospective case review. Methods: The study was conducted at Gruppo Otologico (Piacenza, Italy), a tertiary referral center for neurotology and skull base surgery. In all, 710 patients underwent Translabyrinthine Approach for the removal of vestibular schwannoma at that institution between April 1987 and December 2002. The medical records were retrospectively reviewed to identify tumor size, the incidence of postoperative CSF leak, and its treatment. Results: The overall rate of CSF leak was 1.4%. Conclusion: The use of proper surgical technique minimizes the risk of CSF leak. Study results show that the continued application of the authors' proposed preventive measures resulted in the maintenance of a low rate of CSF leak. Immediate management of CSF fistulae helps prevent meningitis.
Robert W Jyung - One of the best experts on this subject based on the ideXlab platform.
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Retractorless Translabyrinthine Approach for resection of a large acoustic neuroma: operative video and technical nuances.
Neurosurgical focus, 2020Co-Authors: Robert W JyungAbstract:Large acoustic neuromas, greater than 3 cm, can be technically challenging tumors to remove because of their intimate relationship with the brainstem and surrounding cranial nerves. Successful tumor resection involves functional preservation of the facial nerve and neurovascular structures. The Translabyrinthine Approach is useful for surgical resection of acoustic neuromas of various sizes in patients with poor preoperative hearing. The presigmoid surgical corridor allows direct exposure of the tumor in the cerebellopontine angle without any fixed cerebellar retraction. Early identification of the facial nerve at the fundus facilitates facial nerve preservation. Large acoustic tumors can be readily removed with a retractorless Translabyrinthine Approach using dynamic mobilization of the sigmoid sinus. In this operative video atlas report, the authors demonstrate their operative nuances for resection of a large acoustic neuroma via a Translabyrinthine Approach using a retractorless technique. Facial nerve preservation is achieved by maintaining a plane of dissection between the tumor capsule and the tumor arachnoid so that a layer of arachnoid protects the blood supply to the facial nerve. Multilayered closure is achieved with a fascial sling technique in which an autologous fascia lata graft is sutured to the dural defect to suspend the fat graft in the mastoidectomy defect. We describe the step-by-step technique and illustrate the operative nuances and surgical pearls to safely and efficiently perform the retractorless Translabyrinthine Approach, tumor resection, facial nerve preservation, and multi-layered reconstruction of the skull base dural defect to prevent postoperative cerebrospinal fluid leakage. The video can be found here: http://youtu.be/ros98UxqVMw .
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Translabyrinthine Approach for resection of large cystic acoustic neuroma operative video and technical nuances of subperineural dissection for facial nerve preservation
Skull Base Surgery, 2019Co-Authors: Vincent Dodson, Robert W JyungAbstract:The Translabyrinthine Approach is advantageous for the resection of large acoustic neuromas compressing the brainstem when hearing loss is nonserviceable. This Approach provides wide access through the presigmoid corridor without prolonged cerebellar retraction. Early identification of the facial nerve at the fundus is also achieved. In this operative video atlas manuscript, the authors demonstrate a step-by-step technique for microsurgical resection of a large cystic acoustic neuroma via a Translabyrinthine Approach. The nuances of microsurgical and skull base technique are illustrated including performing extracapsular dissection of the tumor while maintaining a subperineural plane of dissection to preserve the facial nerve. This strategy maximizes the extent of removal while preserving facial nerve function. A microscopic remnant of tumor was left adherent to the perineurium. A near-total resection of the tumor was achieved and the facial nerve stimulated briskly at low thresholds. Other than preexisting hearing loss, the patient was neurologically intact with normal facial nerve function postoperatively. In summary, the Translabyrinthine Approach and the use of subperineural dissection are important strategies in the armamentarium for surgical management of large acoustic neuromas while preserving facial nerve function. The link to the video can be found at: https://youtu.be/zld2cSP8fb8 .
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retractorless Translabyrinthine Approach for resection of a large acoustic neuroma operative video and technical nuances
Neurosurgical Focus, 2014Co-Authors: Robert W JyungAbstract:Large acoustic neuromas, greater than 3 cm, can be technically challenging tumors to remove because of their intimate relationship with the brainstem and surrounding cranial nerves. Successful tumor resection involves functional preservation of the facial nerve and neurovascular structures. The Translabyrinthine Approach is useful for surgical resection of acoustic neuromas of various sizes in patients with poor preoperative hearing. The presigmoid surgical corridor allows direct exposure of the tumor in the cerebellopontine angle without any fixed cerebellar retraction. Early identification of the facial nerve at the fundus facilitates facial nerve preservation. Large acoustic tumors can be readily removed with a retractorless Translabyrinthine Approach using dynamic mobilization of the sigmoid sinus. In this operative video atlas report, the authors demonstrate their operative nuances for resection of a large acoustic neuroma via a Translabyrinthine Approach using a retractorless technique. Facial nerve...
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Fascial sling technique for dural reconstruction after Translabyrinthine resection of acoustic neuroma: technical note.
Neurosurgical Focus, 2012Co-Authors: Smruti K. Patel, Amanda J. Podolski, Robert W JyungAbstract:Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the Translabyrinthine Approach is paramount to prevent postoperative CSF leakage. However, primary dural reapproximation and achieving a watertight closure of the dural defect in this anatomical region are quite difficult. Standard closure techniques after the Translabyrinthine Approach often involve packing an abdominal fat graft that plugs the dural defect and mastoidectomy cavity. This technique, however, may pose the risk of direct compression of the fat graft on the facial nerve and brainstem. Nonetheless, even with the evolution in dural repair techniques, postoperative CSF leaks can still occur and provide a route for infection and meningitis. In this report, the authors describe a novel dural “sling” reconstruction technique using autologous fascia lata to repair presigmoid dural defects created after Translabyrinthine resection of acoustic neuromas. The fascia lata is sewn to the edges of the presigmoid dural defe...
Douglas A Chen - One of the best experts on this subject based on the ideXlab platform.
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hydroxyapatite cement cranioplasty following Translabyrinthine Approach long term study of 369 cases
Laryngoscope, 2017Co-Authors: Peter G Volsky, Douglas A Chen, Todd A Hillman, Kellen J Stromberg, Farrel J Buchinsky, Neal M Jackson, Moises A ArriagaAbstract:Objective To report the authors' experience with hydroxyapatite cement (HAC) cranioplasty and analyze the material's long-term safety and efficacy in repairing Translabyrinthine skull-base defects by examining adverse events, specifically cerebrospinal fluid (CSF) leaks and surgical site infections. Study Design Retrospective case-control study (primary study arm); prospective cross-sectional study of patients not examined within the last 5 years (secondary arm). Setting: tertiary-care neurotology private practice and academic practice (two centers). Methods Hydroxyapatite cement implanted following Translabyrinthine Approach, with or without fat graft, was included. Combined Approaches were excluded. Implant-associated adverse events were defined as 1) CSF leaks requiring reoperation or spinal drainage, and (2) infections requiring reoperation. Patients not examined within 5 years were interviewed by telephone to update their condition. Incidence of adverse events was compared to published data for Translabyrinthine cranioplasty using fat graft alone. Implant survival analysis was performed. Results The study cohort included 369 HAC implants in the same number of patients. There were seven CSF leaks and seven infections. Combined (n = 14) incidence of adverse events was 3.8% (2.09%, 6.28%). Compared to fat graft alone, the adverse events associated with HAC were fewer (P < 0.001). Up to 15 years (5,475 days), HAC cement maintained 95% adverse event-free survival. There were no cases of meningitis. Conclusion Cranioplasty using HAC with autologous fat following Translabyrinthine skull-base surgery is safer and more effective than fat graft alone, up to 15 years after surgery. Level of Evidence 4. Laryngoscope, 127:2120–2125, 2017
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Translabyrinthine Approach for acoustic neuroma
Neurosurgery, 2004Co-Authors: Douglas A Chen, Moises ArriagaAbstract:: The Translabyrinthine Approach has been popularized during the past 30 years for the surgical treatment of acoustic neuromas. It serves as an alternative to the retrosigmoid Approach in patients when hearing preservation is not a primary consideration. Patients with a tumor of any size may be treated by the Translabyrinthine Approach. The corridor of access to the cerebellopontine angle is shifted anteriorly in contrast to the retrosigmoid Approach, resulting in minimized retraction of the cerebellum. Successful use of the Approach relies on a number of technical nuances that are outlined in this article.
Mustafa K Baskaya - One of the best experts on this subject based on the ideXlab platform.
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Microsurgical Gross Total Resection of a Large Residual/Recurrent Vestibular Schwannoma via Translabyrinthine Approach
Skull Base Surgery, 2018Co-Authors: Sima Sayyahmelli, Joseph P Roche, Mustafa K BaskayaAbstract:Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a Translabyrinthine Approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed. The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw .
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microsurgical gross total resection of a large residual recurrent vestibular schwannoma via Translabyrinthine Approach
Skull Base Surgery, 2018Co-Authors: Sima Sayyahmelli, Joseph P Roche, Mustafa K BaskayaAbstract:Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a Translabyrinthine Approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed. The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw .
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a stepwise illustration of the Translabyrinthine Approach to a large cystic vestibular schwannoma
Neurosurgical Focus, 2012Co-Authors: Christopher M Nickele, Erinc Akture, Samuel P Gubbels, Mustafa K BaskayaAbstract:Of the presigmoid Approaches, the Translabyrinthine Approach is often used when a large exposure is needed to gain access to the cerebellopontine angle but when hearing preservation is not a concern. At the authors' institution, this Approach is done with the aid of ENT/otolaryngology for temporal bone drilling and exposure. In the present article and video, the authors demonstrate the use of the Translabyrinthine Approach for resection of a large cystic vestibular schwannoma, delineating the steps of positioning, opening, temporal bone drilling, tumor resection, and closure. Gross-total resection was achieved in the featured case. The patient's postoperative facial function was House-Brackmann Grade II on the side ipsilateral to the tumor, although function improved with time. The Translabyrinthine route to the cerebellopontine angle is an excellent Approach for masses that extend toward the midline or anterior to the pons. Although hearing is sacrificed, facial nerve function is generally spared.
Moises Arriaga - One of the best experts on this subject based on the ideXlab platform.
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Translabyrinthine Approach for acoustic neuroma
Neurosurgery, 2004Co-Authors: Douglas A Chen, Moises ArriagaAbstract:: The Translabyrinthine Approach has been popularized during the past 30 years for the surgical treatment of acoustic neuromas. It serves as an alternative to the retrosigmoid Approach in patients when hearing preservation is not a primary consideration. Patients with a tumor of any size may be treated by the Translabyrinthine Approach. The corridor of access to the cerebellopontine angle is shifted anteriorly in contrast to the retrosigmoid Approach, resulting in minimized retraction of the cerebellum. Successful use of the Approach relies on a number of technical nuances that are outlined in this article.
