Flexible endoscopic assistance in the surgical management of vestibular schwannomas
Francesco Corrivetti, Luciano Mastronardi
Introduction: Endoscopic-assisted techniques has frequently been applied to vestibular schwannoma (VS) surgery allowing to increase the extent of resection, minimize complications, and preserve facial nerve and auditory functions.
Objective: In this paper we retrospectively analyze the effectiveness of flexible endoscope for endoscopic-assisted retrosigmoid approach in the surgical management of VS of various size.
Methods: The authors conducted a retrospective analysis on 32 patients who underwent combined microscopic and flexible endoscopic resection of VS of various sizes over a period of 16 months Flexible endoscopic assisted retrosigmoid approach was performed in all cases, and in 6 cases flexible and rigid endoscopic control were used in combination to evaluate the differences between the two surgical instruments.
Results: Gross-total resection was achieved in 84% of the cases and near-total resection was performed in the rest of them. Excellent or good facial nerve function was observed in all except one case with a preoperative severe facial palsy. Hearing preservation surgery (HPS) was attempted in 11 cases and accomplished in 9 (81,8%). A tumor remnant was endoscopically identified in the fundus of the IAC in all cases (100%). Endoscopic assistance increased the rate of total removal and no intrameatal residual tumor was seen at radiological follow-up.
Conclusions: Combined microsurgical and flexible endoscopic assistance provides remarkable advantages in the pursuit of maximal safe resection of VS, preservation of facial nerve and auditory functions, minimizing the risk of post-operative complications.