Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy.
Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
Eur Arch Otorhinolaryngol. 2024 May;281(5):2679-2690. doi: 10.1007/s00405-024-08565-5. Epub 2024 Mar 22.
The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development.
This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I-II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7 months.
We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6 months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully.
The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.
经扩大经岩前-经迷路入路（ExpTTA）是治疗前庭神经鞘瘤的一种新的手术入路。最初的纯内镜版本已经得到了显微镜的补充，现在它是治疗主要位于内听道的小至中型前庭神经鞘瘤的一种可能的手术选择之一，这些患者的听力无法保留。
这是一组 54 例患者的系列病例，他们在 2016 年 1 月至 2023 年 1 月期间接受了经扩大经迷路经岩前入路显微切除术治疗单侧散发性前庭神经鞘瘤，主要为 Koos I-II 级，听力无法保留。我们描述了手术技术，重点介绍了解剖学标志，并分析了其优缺点。介绍了临床结果的回顾性分析，包括早期和晚期并发症。平均随访时间为 46.7 个月。
所有病例均达到了病变的大体全切除，在每次手术后至少 6 个月的首次随访 MRI 上得到证实。我们没有记录到任何术中并发症或疾病复发。我们记录了两例术后严重面神经瘫痪，其中一例是永久性的。没有报告致残性眩晕或失衡的病例，所有患者报告在日常生活活动中完全恢复自主能力。三例耳漏成功地进行了保守治疗。
经迷路经岩前入路结合了内镜的优点和显微镜手术的可能性。我们的经验证实了它在手术并发症和面神经结局方面的安全性。对于听力受损的小至中型神经鞘瘤患者，特别是年轻患者，该方法是一种治疗选择，可确保根治性切除、疾病控制和最小的发病率。
