Related Experiment Video
Updated: Nov 19, 2025
The Microscopic Transcanal Approach in Stapes Surgery Revisited
Published on: February 16, 2022
A microscope-assisted endoscopic transcanal transpromontorial approach for vestibular schwannoma resection: a
Chen Jianqing1,2,3, Chai Yongchuan1,2,3, Zhang Zhihua1,2,3
1Department of Otolaryngology-Head and Neck Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
Objective:
To evaluate the feasibility of a microscope-assisted endoscopic transcanal transpromontorial approach (METTA) for the removal of small vestibular schwannomas (VS) limited to the internal auditory canal (IAC), and introduce a modification without external auditory canal (EAC) closure.
Methods:
Between August 2018 and February 2019, seven patients with intrameatal VS underwent surgery in our center, endoscopic transcanal transpromontorial approach was applied in the first 2 patients and the rest 5 patients were operated via METTA. Treatment outcomes including efficacy of tumor resection, facial nerve outcome, operation time and post-operative course were recorded and analyzed.
Results:
All seven patients were pathologically confirmed to have intrameatal VS. Total tumor removal was achieved in all cases. Two patients experienced cerebrospinal fluid leakage which resolved spontaneously within 5 days. The average operation time was 161.41 ± 18.42 min. All patients presented normal facial nerve function 1 month after surgery.
Conclusion:
The METTA was effective in the removal of intrameatal VS. It can be an alternative surgical option for intrameatal VS with no serviceable hearing.
Insights
The microscope-assisted endoscopic transcanal transpromontorial approach (METTA) effectively removes small vestibular schwannomas (VS) within the internal auditory canal. This technique offers a viable surgical option for patients with VS and no serviceable hearing.
Area of Science:
- Neurosurgery
- Otolaryngology
- Neurosurgical Oncology
Background:
- Vestibular schwannomas (VS) are tumors originating from the Schwann cells of the vestibulocochlear nerve.
- Intrameatal VS are small tumors confined to the internal auditory canal (IAC).
- Surgical removal is a primary treatment modality for VS.
Purpose of the Study:
- To assess the feasibility of the microscope-assisted endoscopic transcanal transpromontorial approach (METTA) for intrameatal VS.
- To evaluate a modified METTA technique without external auditory canal (EAC) closure.
- To analyze treatment outcomes including tumor resection, facial nerve function, and postoperative course.
Main Methods:
- Seven patients with intrameatal VS underwent surgery.
- The initial two patients were treated with an endoscopic transcanal transpromontorial approach.
- The subsequent five patients were treated with the modified METTA, without EAC closure.
Main Results:
- All seven patients achieved total tumor removal.
- Two patients experienced transient cerebrospinal fluid leakage, resolving within 5 days.
- Average operative time was 161.41 ± 18.42 minutes, with all patients maintaining normal facial nerve function postoperatively.
Conclusions:
- METTA is an effective surgical approach for removing intrameatal VS.
- This technique is a potential alternative for patients with intrameatal VS and no serviceable hearing.
- The modified METTA without EAC closure demonstrates promising results.
