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Published on: January 17, 2018
Translabyrinthine approach to the cerebellopontine angle
Simon K W Lloyd1, Walter Kutz2
1Department of Otolaryngology Head and Neck Surgery, Northern Care Alliance NHS Foundation Trust, Salford Royal Hospital, Manchester, United Kingdom; Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Faculty of Biology, Medicine and Health, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
The translabyrinthine approach offers excellent cerebellopontine angle (CPA) access for tumor removal by removing bone, not brain tissue. This surgical technique aids facial nerve preservation but sacrifices hearing due to vestibular apparatus removal.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- The translabyrinthine approach is a common surgical method for accessing the cerebellopontine angle (CPA).
- Popularized in the 1960s, it is frequently used for vestibular schwannoma removal.
- This technique accesses the CPA by removing bone, avoiding brain retraction.
Purpose of the Study:
- To describe the indications and surgical technique of the translabyrinthine approach.
- To highlight the advantages of this approach, including facial nerve identification and preservation.
- To discuss potential complications and optimization strategies for surgical outcomes.
Main Methods:
- Detailed description of the translabyrinthine surgical technique.
- Emphasis on bone removal for CPA access and facial nerve identification.
- Discussion of modifications, such as cochlear removal for extended access.
Main Results:
- Provides excellent access to the CPA and intracanalicular tumor portions.
- Facilitates proximal and distal facial nerve identification, aiding nerve preservation.
- Results in sacrifice of the vestibular apparatus and associated hearing.
Conclusions:
- The translabyrinthine approach is a valuable technique for CPA lesions, particularly vestibular schwannomas.
- Its advantages include bone removal access and enhanced facial nerve preservation.
- Hearing sacrifice is an inherent consequence, necessitating careful patient selection.
