Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas
The classical middle cranial fossa approach (MCFA) for vestibular schwannoma (VS) removal often requires a large incision and craniotomy, excessive temporal lobe manipulation, and a longer recovery. We describe a keyhole MCFA (KMCFA) with endoscopic assistance that allows for adequate access with mi...
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MDPI AG
2022-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/9/2324 |
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| author | In Seok Moon Ick Soo Choi Seung Ho Shin Seungjoon Yang Youngrak Jung Gina Na |
| author_facet | In Seok Moon Ick Soo Choi Seung Ho Shin Seungjoon Yang Youngrak Jung Gina Na |
| author_sort | In Seok Moon |
| collection | DOAJ |
| description | The classical middle cranial fossa approach (MCFA) for vestibular schwannoma (VS) removal often requires a large incision and craniotomy, excessive temporal lobe manipulation, and a longer recovery. We describe a keyhole MCFA (KMCFA) with endoscopic assistance that allows for adequate access with minimal temporal lobe manipulation, resulting in a fast recovery and an invisible scar. Eight sides of four cadaveric heads were dissected through the endoscopic-assisted KMCFA to access the internal auditory canal (IAC). Furthermore, five patients with intracanalicular VS underwent tumor removal with the endoscopic-assisted KMCFA. During the endoscopic-assisted KMCFA with fine instruments, a 3-cm supra-auricular incision and a 2-cm diameter keyhole craniotomy achieved exposure of the entire length of the IAC in all cadaveric dissections without unintended violation of the cochlea, semicircular canal, and facial nerve. The gross tumor was totally removed in five patients with no major postoperative complications. The surgical time was reduced, the hearing outcomes were similar to those of the classical MCFA, and the scar was invisible 1 month after the surgery. The endoscopic-assisted KMCFA permits intracanalicular VS removal in a safe, efficient, and cosmetic way. For small intracanalicular VSs, this approach can replace the classical MCFA when indicated. |
| first_indexed | 2024-03-10T04:02:10Z |
| format | Article |
| id | doaj.art-31de6799584d46b981f744c3a9b97b4f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T04:02:10Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-31de6799584d46b981f744c3a9b97b4f2023-11-23T08:30:42ZengMDPI AGJournal of Clinical Medicine2077-03832022-04-01119232410.3390/jcm11092324Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular SchwannomasIn Seok Moon0Ick Soo Choi1Seung Ho Shin2Seungjoon Yang3Youngrak Jung4Gina Na5Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang 10380, KoreaDepartment of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, KoreaThe classical middle cranial fossa approach (MCFA) for vestibular schwannoma (VS) removal often requires a large incision and craniotomy, excessive temporal lobe manipulation, and a longer recovery. We describe a keyhole MCFA (KMCFA) with endoscopic assistance that allows for adequate access with minimal temporal lobe manipulation, resulting in a fast recovery and an invisible scar. Eight sides of four cadaveric heads were dissected through the endoscopic-assisted KMCFA to access the internal auditory canal (IAC). Furthermore, five patients with intracanalicular VS underwent tumor removal with the endoscopic-assisted KMCFA. During the endoscopic-assisted KMCFA with fine instruments, a 3-cm supra-auricular incision and a 2-cm diameter keyhole craniotomy achieved exposure of the entire length of the IAC in all cadaveric dissections without unintended violation of the cochlea, semicircular canal, and facial nerve. The gross tumor was totally removed in five patients with no major postoperative complications. The surgical time was reduced, the hearing outcomes were similar to those of the classical MCFA, and the scar was invisible 1 month after the surgery. The endoscopic-assisted KMCFA permits intracanalicular VS removal in a safe, efficient, and cosmetic way. For small intracanalicular VSs, this approach can replace the classical MCFA when indicated.https://www.mdpi.com/2077-0383/11/9/2324vestibular schwannomaminimally invasivemiddle cranial fossaendoscope |
| spellingShingle | In Seok Moon Ick Soo Choi Seung Ho Shin Seungjoon Yang Youngrak Jung Gina Na Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas Journal of Clinical Medicine vestibular schwannoma minimally invasive middle cranial fossa endoscope |
| title | Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas |
| title_full | Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas |
| title_fullStr | Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas |
| title_full_unstemmed | Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas |
| title_short | Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas |
| title_sort | endoscopic assisted keyhole middle cranial fossa approach for small vestibular schwannomas |
| topic | vestibular schwannoma minimally invasive middle cranial fossa endoscope |
| url | https://www.mdpi.com/2077-0383/11/9/2324 |
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