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Endoscopic intracanalicular vestibular schwannoma excision via middle ear corridors a surgical options
Tengku Mohamed Izam Tengku Kamalden1, Khairunnisak Misron1, Puvan Arul Arumugam1
1Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Sultan Ismail, Johor Bahru, Johor, Malaysia.
Background:
With more intracanalicular vestibular schwannoma (ICVS) diagnosed, treatment options are limited either to wait-and-see or surgery. The transpromontorial and infrapromontorial approaches allow direct route to the fundus of internal auditory canal with certain advantages in preserving facial nerve and even cochlear nerve.
Objectives:
To describe the middle ear corridor approach for ICVS excision.
Methodology:
All transpromontorial and infrapromontorial approaches for ICVS excision were recruited. The surgeries were performed at an otologic center by a single experienced otologist.
Results:
Three cases of ICVS Koos Type I were included in this review. Two cases were operated with exclusive endoscopic transcanal transpromontorial approach excision of tumor. One case underwent concurrent transcanal excision of ICVS through infrapromontorial approach with cochlear implantation. Two of them developed facial nerve paresis. The last patient recovered fully with viable cochlear nerve enabling hearing restoration with cochlear implant.
Conclusion:
The potential of surgery in ICVS via middle ear approach is a safe and direct route with promising outcome. This approach offers removal of the ICVS without interrupting facial and cochlear nerves. Hence, the preservation of facial function and hearing are possible.
