Almefty Rami O, Essayed Walid Ibn, Al-Mefty Ossama
Department of Neurosurgery, Temple University, Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Oper Neurosurg. 2021 Jul 15;21(2):E101-E102. doi: 10.1093/ons/opab129.
Medial acoustic tumors are a rare distinct type of vestibular schwannoma having distinguished clinical and radiological features.1 Originating medially in the cerebellopontine angle without extending into the lateral internal auditory meatus, they are frequently giant in size at presentation in younger patients with a relatively preserved hearing, while they have other neurological deficits from cerebellar or brainstem compression and associated hydrocephalus. Imaging typically shows a cystic tumor with local mass effect and an internal auditory canal filled with cerebrospinal fluid.1,2 Surgical resection of theses schwannoma is particularly challenging not only due to their size and hypervascularity, but also given their particular arachnoidal rearrangement inducing marked adherence to the brainstem and facial nerve.2 The treatment is surgical resection, despite, however, their giant size hearing preservation should be sought and is attainable.1-5 Transmastoid approach with squeletonization and reflection of the transverse sigmoid sinus provides lateral exposure avoiding cerebellar retraction.6 In this report, we demonstrate the specific surgical considerations applied to the resection of a giant medial acoustic tumor in a 40-yr-old patient presenting with ataxia, vertigo, facial paresthesia, and intact hearing. The patient agreed to the surgery and photography. Image at 1:44 © Ossama Al-Mefty, used with permission; Image at 8:21 from Dunn et al,2 used with permission from JNSPG.
内侧听神经瘤是一种罕见的特殊类型的前庭神经鞘瘤，具有独特的临床和影像学特征。1 它起源于桥小脑角内侧，不延伸至内耳道外侧，在听力相对保留的年轻患者中，肿瘤通常在初诊时就很大，同时伴有小脑或脑干受压及相关脑积水导致的其他神经功能缺损。影像学检查通常显示为囊性肿瘤，伴有局部占位效应，内耳道充满脑脊液。1,2 这些神经鞘瘤的手术切除尤其具有挑战性，不仅因为其大小和血管丰富，还因其特殊的蛛网膜重排导致与脑干和面神经明显粘连。2 治疗方法是手术切除，尽管肿瘤巨大，但仍应寻求并有可能保留听力。1-5 经乳突入路并进行横窦乙状窦骨骼化和翻转，可提供外侧暴露，避免小脑牵拉。6 在本报告中，我们展示了针对一名 40 岁患有共济失调、眩晕、面部感觉异常且听力完好的巨大内侧听神经瘤患者进行切除时的具体手术考量。患者同意手术及拍照。 1:44 的图片 © 奥萨马·阿尔-梅夫蒂，经许可使用；8:21 的图片来自邓恩等人，2 经《神经外科实践杂志》许可使用。
