Resection of Vestibular Schwannoma Through Middle Cranial Fossa Approach with Endoscopic Assistance

We sought to report the outcome of resection of vestibular schwannomas (VSs) originating from the inferior vestibular nerve that extended into the fundus of the internal auditory canal through the middle cranial fossa (MCF) approach with endoscopic assistance.

Seven patients with VSs who underwent resection through MCF approach with endoscope assistance and 12 patients with conventional microsurgery in our department were enrolled in this study. These patients' characteristics were acquired, and the surgical outcomes, as well as postoperative complications, were evaluated.

In the endoscope group, the VS was first removed by a conventional microscopic procedure and then an endoscope was used to find and remove any residue lesions. In 3 of 7 patients, residue tumor in the space below transverse crest was found and completely removed under endoscope. Six of 7 patients (85.7%) had House-Brackmann grade I at the time of last follow-up in the endoscope group compared with 10 of 12 patients (83.3%) in the conventional microsurgery group. Serviceable hearing was successfully maintained in 2 of 3 patients (66.7%) in the endoscope group compared with 6 of 10 patients (60%) in the conventional microsurgery group. Total resections were achieved in all the patients (100%) in the endoscope group compared with 9 of 12 patients (75%) in the conventional microsurgery group.

Using an endoscope in VS resection through the MCF approach could facilitate complete removal of the lesion while minimizing the risk of hearing loss and facial paralysis. The endoscope-assisted MCF approach is especially suitable for removing an intracanalicular VS with lateral extension involving the space below the transverse crest.