Endoscope-Assisted Minimally Invasive Microsurgical Removal of a Medium-Sized Acoustic Neuroma (T3a) through a Retrosigmoid Mini-Craniotomy with Preservation of Hearing

Peter Kurucz; Laszlo Barany; Michael Buchfelder; Oliver Ganslandt

doi:10.1055/s-0038-1677488

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 03): S276-S278
DOI: 10.1055/s-0038-1677488

Skull Base: Operative Videos

Georg Thieme Verlag KG Stuttgart · New York

Endoscope-Assisted Minimally Invasive Microsurgical Removal of a Medium-Sized Acoustic Neuroma (T3a) through a Retrosigmoid Mini-Craniotomy with Preservation of Hearing

Authors

Peter Kurucz

¹Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany

²Department of Neurosurgery, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Bayern, Germany
Laszlo Barany

³Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
Michael Buchfelder

²Department of Neurosurgery, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Bayern, Germany
Oliver Ganslandt

¹Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany

Abstract

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Keywords

acoustic neuroma - endoscope-assisted microsurgery - minimally invasive - keyhole approach - retrosigmoid craniotomy

Fig. 1 Pre- and Postoperative MRI images. Preoperative CISS (A) and contrast-agent enhanced T1-weighted (B) MRI-scans showed a medium-sized (T3a) acoustic neuroma on the right side with slightly protrusion into the internal auditory canal. The cerebellopontine angle is filled by the tumor and the surface of the brainstem is in a gently contact with the lesion. The postoperative CISS (C) and contrast-agent enhanced T1-weighted (D) MRI-scans 3 months after the surgery verified the complete tumor removal.

Fig. 2 Intraoperative photomicrographs. (A) Microscopic view of the tumor through the retrosigmoid mini-craniotomy. (B) Overview of the tumor and the surrounding anatomical structures through the 30 degree endoscope. (C) Detection of the cochlear and facial nerves with a 30 degree endoscope prior to the tumor resection. (D) Microscopic view of the operative field with the intact cochlear and facial nerves after complete resection of the tumor. AICA, anterior inferior cerebellar artery; AN, acoustic neuroma; IAM, internal auditory meatus; nV, trigeminal nerve; nVII, facial nerve; nVIII, cochlear nerve; petr. v., superior petrosal vein; tent, tentorium.

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Figures

Fig. 1 Pre- and Postoperative MRI images. Preoperative CISS (A) and contrast-agent enhanced T1-weighted (B) MRI-scans showed a medium-sized (T3a) acoustic neuroma on the right side with slightly protrusion into the internal auditory canal. The cerebellopontine angle is filled by the tumor and the surface of the brainstem is in a gently contact with the lesion. The postoperative CISS (C) and contrast-agent enhanced T1-weighted (D) MRI-scans 3 months after the surgery verified the complete tumor removal.

Fig. 2 Intraoperative photomicrographs. (A) Microscopic view of the tumor through the retrosigmoid mini-craniotomy. (B) Overview of the tumor and the surrounding anatomical structures through the 30 degree endoscope. (C) Detection of the cochlear and facial nerves with a 30 degree endoscope prior to the tumor resection. (D) Microscopic view of the operative field with the intact cochlear and facial nerves after complete resection of the tumor. AICA, anterior inferior cerebellar artery; AN, acoustic neuroma; IAM, internal auditory meatus; nV, trigeminal nerve; nVII, facial nerve; nVIII, cochlear nerve; petr. v., superior petrosal vein; tent, tentorium.