title: Decision making in dissection range of temporal bone: refinements to enlarged translabyrinthine approach.
abstract: The aim of the study was to describe the refinements to the classic enlarged translabyrinthine approach (ETLA) by modifying the bony dissection range of temporal bone and to analyze the main outcomes achieved in a series of vestibular schwannoma (VS) cases submitted to microsurgery by ETLA. This was a retrospective study of 382 patients who underwent VS surgical removal via ETLA between January 2001 and December 2012. Among those cases, 332 were via classic ETLA, while 28 cases were via ETLA with blind sac technique and middle ear eradication and 22 via transotic approach. Total tumor removal was achieved in 368 cases, whereas near total removal in 11 patients and subtotal in 3 patients. In cases of large VS (>3 cm) via classic ETLA, good short-term and long-term facial nerve function (HB I-II) was gained in 27.8 % (32/115) and 42.6 % (49/115) cases, respectively, meanwhile in VS operated via blind sac technique, good short-term (p = 0.048) and long-term (p = 0.044) facial nerve function was reached in 44.0 % (22/50) and 60.0 % (30/50) cases, respectively. Postoperative facial nerve function was proved to be better in modified ETLA group. CSF leakage occurred in 16 (4.2 %) patients via classic ETLA. In 115 cases of large VS (>3 cm), postoperative CSF leakage occurred in 10 (8.7 %) patients. Whereas in 50 cases via blind sac technique, none developed CSF leakage (p = 0.03). The incidence of CSF leakage was lower in modified ETLA group. Our refinements to classic ETLA by changing the temporal bone resection range provide a wide surgical field, well prevention of CSF leakage and preservation of facial nerve function in large VS.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.|School of Medicine, Ear Institute, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
authors.forename: Zheng Jie
authors.initials: ZJ
authors.lastname: Zhu
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.|School of Medicine, Ear Institute, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
authors.forename: Wei Dong
authors.initials: WD
authors.lastname: Zhu
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.|School of Medicine, Ear Institute, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China.
authors.forename: Hong Sai
authors.initials: HS
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China. wzyent@163.com.|School of Medicine, Ear Institute, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China. wzyent@163.com.
authors.forename: Zhao Yan
authors.identifier: http://orcid.org/0000-0001-6065-7045
authors.initials: ZY
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China. wuhao622@sina.cn.|School of Medicine, Ear Institute, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China. wuhao622@sina.cn.
authors.forename: Hao
authors.initials: H
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D000066491:Clinical Decision-Making; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Acoustic neuroma; Enlarged translabyrinthine approach; Facial nerve function; Surgical complications; Vestibular schwannoma