Endoscopic-assisted microsurgical resection of giant vestibular schwannoma in semi-sitting position.

Gang Song,Yuhai Bao,Jiantao Liang,Liyong Sun

doi:10.3171/2021.7.focvid2176

Abstract

The main objectives of microsurgery for vestibular schwannoma are total tumor removal and preservation of facial and cochlear nerve function. For giant tumors, total tumor removal and facial nerve function preservation are challenging. The semisitting position has some advantages. In this video the authors show the removal of a giant vestibular schwannoma with the patient in a semisitting position. They demonstrate the advantages of the semisitting technique, such as the two-handed microsurgical dissection technique and a clear operative field. Finally, a small residual tumor in the internal auditory canal was removed by endoscopy. The patient’s facial function was House-Brackmann grade I at discharge.The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2176

Highlights

The main objectives of microsurgery for vestibular schwannoma are total tumor removal and preservation of facial and cochlear nerve function
Preoperative computed tomography (CT) scan revealed that the internal acoustic canal (IAC) was enlarged
We used the facial stimulation polar to stimulate the dorsal side of the tumor to exclude the presence of the facial nerve (FN) on the surface of the tumor

Summary

Introduction

The main objectives of microsurgery for vestibular schwannoma are total tumor removal and preservation of facial and cochlear nerve function. This video demonstrates endoscopy-assisted microsurgical resection of a giant vestibular schwannoma (VS) in the semisitting position.[1] Audiometric examination revealed hearing loss in the left ear. Magnetic resonance imaging (MRI) showed a homogeneously enhanced tumor in the left cerebellopontine angle, extending into the internal acoustic canal (IAC). The brainstem was compressed by the tumor.

Results

Conclusion