title: Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment.
abstract: OBJECTIVE The aim of this study was to describe the first case series in which an exclusive endoscopic transcanal transpromontorial approach (EETTA) was used to treat small vestibular schwannomas (VSs) and meningiomas of the internal auditory canal (IAC). METHODS The authors performed a retrospective review of patients who had undergone surgery using an EETTA to the IAC at 2 university tertiary care referral centers during the period from November 2011 to January 2015. RESULTS Ten patients underwent surgery via an EETTA for the treatment of VS in the IAC at the University Hospital of Modena or the University Hospital of Verona. The patients had Koos Grade I or II tumors and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Class D hearing status preoperatively. Gross-total resection was achieved in all patients. No major complications such as cerebrospinal fluid leakage or hemorrhage were reported. In 7 of 10 (70%) patients, facial nerve function was normal immediately after surgery (Rough Grading System [RGS] Grade I). Two patients presented with a transitory facial palsy immediately after surgery (RGS Grade II-III) but experienced complete recovery during the follow-up period. The mean follow-up was 10 months. CONCLUSIONS The EETTA proved to be successful for the removal of VS or meningioma involving the cochlea, fundus, and IAC, with possible lower complication rates and less invasive procedures than those for traditional microscopic approaches. The potential for the extensive and routine use of this approach in lateral and posterior skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among the otolaryngological and neurosurgical communities.
authors.affiliation: Departments of 1 Otolaryngology-Head and Neck Surgery and.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marchioni
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena; and.|Department of Neurosurgery, New Civil Hospital Sant'Agostino-Estense, Baggiovara, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Alicandri-Ciufelli
authors.affiliation: Departments of 1 Otolaryngology-Head and Neck Surgery and.
authors.forename: Alessia
authors.initials: A
authors.lastname: Rubini
authors.affiliation: Neurosurgery, University Hospital of Verona, Verona.
authors.forename: Babara
authors.initials: B
authors.lastname: Masotto
authors.affiliation: Department of Neurosurgery, New Civil Hospital Sant'Agostino-Estense, Baggiovara, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pavesi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena; and.
authors.forename: Livio
authors.initials: L
authors.lastname: Presutti
mesh_terms: D000328:Adult; D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D000160:Vestibulocochlear Nerve Diseases / Q000601:surgery*
keywords: AAO-HNS = American Academy of Otolaryngology–Head and Neck Surgery; CPA = cerebellopontine angle; CS = cochlear schwannoma; CSF = cerebrospinal fluid; EAC = external auditory canal; EETTA = exclusive endoscopic transcanal transpromontorial approach; IAC = internal auditory canal; ICU = intensive care unit; RGS = Rough Grading System; VS = vestibular schwannoma; endoscopic ear surgery; inner ear; internal auditory canal; surgical technique; transcanal approach; vestibular schwannoma