Transcanal Transpromontorial Approaches to the Internal Auditory Canal: A Systematic Review

Area of Science:

• Neurosurgery
• Otolaryngology
• Minimally Invasive Surgery

Background:

• Internal auditory canal (IAC) lesions present surgical challenges.
• Endoscopic transcanal transpromontorial approaches (EETTA/ExpTTA) offer minimally invasive options for IAC pathologies.
• Evaluating the efficacy and safety of EETTA/ExpTTA is crucial for surgical decision-making.

Approach:

• A systematic literature review and meta-analysis were conducted.
• Studies reporting EETTA/ExpTTA for IAC pathologies were included.
• Outcomes, including complete resection rates and complication rates (especially facial nerve function), were meta-analyzed.

Key Points:

• All 173 patients across 16 studies achieved gross-total resection of IAC lesions.
• Transient complications occurred in 17.3% of patients, with 9% experiencing facial nerve palsy that resolved.
• Persistent complications occurred in 19.6%, including persistent facial nerve palsy in 12.7%.

Conclusions:

• EETTA and ExpTTA demonstrate high rates of complete resection for IAC lesions.
• While effective, these transpromontorial approaches have associated risks of facial nerve complications.
• Further research may refine indications and techniques to optimize outcomes for IAC surgery.