Mazzoni A, Zanoletti E, Faccioli C, Martini A
Department of Neuroscience, Otolaryngology Unit, Padova University, via Giustiniani 2, 35128, Padova, Italy.
Eur Arch Otorhinolaryngol. 2017 May;274(5):2149-2154. doi: 10.1007/s00405-017-4501-3. Epub 2017 Feb 27.
Intracochlear schwannomas can occur either as an extension of a larger tumor from the internal auditory canal, or as a solitary labyrinthine tumor. They are currently removed via a translabyrinthine approach extended to the basal turn, adding a transotic approach for tumors lying beyond the basal turn. Facial bridge cochleostomy may be associated with the translabyrinthine approach to enable the whole cochlea to be approached without sacrificing the external auditory canal and tympanum. We describe seven cases, five of which underwent cochlear schwannoma resection with facial bridge cochleostomy, one case with the same procedure for a suspect tumor and one, previously subjected to radical tympanomastoidectomy, who underwent schwannoma resection via a transotic approach. Facial bridge cochleostomy involved removing the bone between the labyrinthine and tympanic portions of the fallopian canal, and exposing the cochlea from the basal to the apical turn. Patients' recovery was uneventful, and long-term magnetic resonance imaging showed no residual tumor. Facial bridge cochleostomy can be a flexible extension of the translabyrinthine approach for tumors extending from the internal auditory canal to the cochlea. The transcanal approach is suitable for the primary exclusive intralabyrinthine tumor. The indications for the different approaches are discussed.
耳蜗内神经鞘瘤可作为较大肿瘤从内耳道延伸而来，或作为孤立的迷路肿瘤出现。目前通过延伸至蜗底转的经迷路入路切除，对于位于蜗底转以外的肿瘤则增加经外耳道入路。面神经桥蜗开窗术可与经迷路入路联合应用，以便在不牺牲外耳道和鼓膜的情况下接近整个耳蜗。我们描述了7例病例，其中5例行面神经桥蜗开窗术切除耳蜗神经鞘瘤，1例对疑似肿瘤行相同手术，1例曾接受根治性鼓室乳突切除术，此次经外耳道入路切除神经鞘瘤。面神经桥蜗开窗术包括去除面神经管迷路段和鼓室段之间的骨质，暴露从蜗底转到蜗顶的耳蜗。患者恢复顺利，长期磁共振成像显示无残留肿瘤。面神经桥蜗开窗术可作为经迷路入路的灵活扩展，用于治疗从内耳道延伸至耳蜗的肿瘤。经耳道入路适用于原发性单纯迷路内肿瘤。文中讨论了不同手术入路的适应证。
