The outcomes and techniques of resection of intracanalicular vestibular schwannomas through middle fossa approach

Abstract

Objective To investigate the surgical outcomes and techniques of middle fossa (MF) approach for resection of intracanalicular vestibular schwannomas. Methods Ten patients diagnosed with intracanalicular vestibular schwannoma underwent surgery treatment through MF approach at Department of Neurosurgery, Tangdu Hospital, Airforce Military Medical University from January 2012 to December 2015. The effects of surgery on hearing and facial nerve functions were assessed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification and House-Brackmann (H-B) grading system, respectively. Results All patients achieved complete resection of tumor. Intracranial infection occurred in 1 case. There was no death or cerebrospinal fluid (CSF) leakage. The MRI results at 6-12 months post surgery suggested no recurrence of tumor. The rate of postoperative effective hearing (class A/B) preservation was 4/5, and the rate of functional facial nerve (class Ⅰ/Ⅱ) preservation rate was 9/10. Conclusions For intracanalicular vestibular schwannomas, microsurgery via the MF approach could offer good preservation of hearing and facial nerve functions. Being familiar with the anatomy and techniques of MF approach would help to reduce the operative complications. Key words: Neuroma, acoustic; Neurosurgical procedures; Internal acoustic canal; Middle fossa approach; Hearing preservation