Combined translabyrinthine, anterior petrosal approach for resection of collision vestibular schwannoma and petrous apex meningioma in neurofibromatosis type 2, with auditory brainstem implant placement.

Usman A Khan,Marc S Schwartz,Jillian H Plonsker,Rick A Friedman

doi:10.3171/2021.7.focvid21130

Usman A Khan, Marc S Schwartz + Show 2 more

Open Access

https://doi.org/10.3171/2021.7.focvid21130

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Abstract

The natural history of neurofibromatosis type 2 (NF2) is profound bilateral hearing loss. The decision to pursue microsurgery may be more complicated in NF2 than with sporadic tumors. Schwannomas in NF2 often occur with other skull base tumors. Treatment should be tailored to preserve auditory perception for as long as possible. The authors present the case of a man with NF2 and a vestibular schwannoma who has poor hearing on the same side as a large petrous apex meningioma, both opposite to a well-hearing ear. This case highlights surgical decision-making and technical nuances during resection of collision tumors in NF2.The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21130

Highlights

This video demonstrates a combined right translabyrinthine and anterior petrosal approach for resection of a petrous apex meningioma in collision with a vestibular schwannoma in a young male with neurofibromatosis type 2 (NF2)
Preoperative MRI shows a large petrous apex meningioma with a dural base lateral to Meckel’s cave. This meningioma has a component that enters the posterior fossa to the level of the IAC, where enhancement shows a 2.5 × 2–cm vestibular schwannoma
3:59 With the translabyrinthine approach complete, we turn our attention to the middle fossa approach, beginning with peeling of the middle fossa dura from the posteriorto-anterior direction to protect greater superficial petrosal nerve

Summary

Introduction

This video demonstrates a combined right translabyrinthine and anterior petrosal approach for resection of a petrous apex meningioma in collision with a vestibular schwannoma in a young male with NF2. This meningioma has a component that enters the posterior fossa to the level of the IAC (internal auditory canal), where enhancement shows a 2.5 × 2–cm vestibular schwannoma. This patient had poor hearing on the right side and good hearing on the left, which made the recommendation to pursue resection of the right schwannoma straightforward. Resection of NF2 schwannoma in a good- or only-hearing ear makes this recommendation more challenging.

Results

Conclusion