Impact of video-endoscopy on the results of retrosigmoid-transmeatal microsurgery of vestibular schwannoma: prospective
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OTOLOGY
Impact of video-endoscopy on the results of retrosigmoidtransmeatal microsurgery of vestibular schwannoma: prospective study Martin Chovanec • Eduard Zveˇrˇina • ˇ akrt Oliver Profant • Jirˇ´ı Skrˇivan • Ondrˇej C • Jirˇ´ı Lisy´ Jan Betka
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Received: 4 March 2012 / Accepted: 5 July 2012 / Published online: 4 August 2012 Ó Springer-Verlag 2012
Abstract Endoscopy-assisted microsurgery represents modern trend of treatment of the cerebellopontine angle (CPA) pathologies including vestibular schwannoma (VS). Endoscopes are used in adjunct to microscope to achieve better functional results with less morbidity. Angled optics, magnification and illumination enable superior view in the operative field. Consecutive 89 patients with untreated unilateral sporadic vestibular schwannoma undergoing tumor resection via a retrosigmoid approach during 2008–2010 were prospectively analysed. Endoscopyassisted microsurgical (EA-MS) removal was performed in 39 cases (Grade 1: 2, Grade 2: 5, Grade 3: 9, Grade 4: 22, Grade 5: 1) and microsurgical (MS) removal was performed in 50 cases (Grade 1: 1, Grade 2: 3, Grade 3: 9, Grade 4: 34, Grade 5: 3). Minimally invasive approach with craniotomy B2.5 cm was employed for small tumors (Grade 1 and 2) in the EA-MS group. Endoscopic
technique was used for monitoring of neuro-vascular anatomy in CPA, during dissection of the meatal portion of tumors, assessment of radicality and for identification of potential pathways for CSF leak formation. All cases in MS group were deemed as radically removed. In the EA-MS group, residual tumor tissue in the fundus of internal auditory canal not observable with microscope was identified with endoscope in four cases. Such cases were radicalized. Tumor recurrence was not observed during the follow-up in EA-MS group. There is a suspicious intrameatal tumor recurrence on the repeated MRI scan in one patient in the MS group. Neither mortality nor infection was observed. The most common complication was pseudomeningocele (EA-MS 20 cases; MS 23). It was managed with aspiration with or without tissue-gluing in all cases without the need for any surgical revision. Adjunctive use of endoscope in the EA-MS group identified potential
M. Chovanec (&) E. Zveˇrˇina O. Profant J. Skrˇivan J. Betka Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles ´ valu 84, 150 06 Prague 5, Czech Republic University, V U e-mail: [email protected]
ˇ akrt O. C Department of Rehabilitation and Sport Medicine, 2nd Faculty of Medicine, University Hospital Motol, Charles ´ valu 84, 150 06 Prague 5, Czech Republic University, V U
M. Chovanec Institute of Anatomy, 1st Faculty of Medicine, Charles University, Prague, Czech Republic E. Zveˇrˇina Department of Neurosurgery, 3rd Faculty of Medicine, Faculty Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
ˇ akrt O. C Joint Centre for Biomedical Engineering, Faculty of Biomedical Engineering, Czech Technical University and Charles Univer
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