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Understanding the Translabyrinthine Approach for Neurosurgery Residents: Operative and Educational Video.

Beste Gülsuna¹, Xiaochun Zhao¹, Alexander G Bien²

¹Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States.

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|February 16, 2026

Summary

This study demonstrates the translabyrinthine resection of a large vestibular schwannoma, achieving near-total removal with functional preservation. The video highlights surgical techniques for this complex eighth cranial nerve tumor.

Keywords:

facial nerve preservation intraoperative monitoring skull base surgery translabyrinthine approach vestibular schwannoma

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Area of Science:

Neurosurgery
Otolaryngology
Neuron Tumors

Background:

Vestibular schwannomas are benign tumors of the eighth cranial nerve.
Large tumors (>3cm) can cause significant neurological deficits.
Microsurgical resection is often necessary for large vestibular schwannomas.

Purpose of the Study:

To demonstrate the translabyrinthine resection technique for a large vestibular schwannoma.
To highlight surgical anatomy, technique, and intraoperative decision-making.
To provide an educational framework for neurosurgery residents.

Main Methods:

Demonstration of translabyrinthine resection of a 3.2-cm left-sided vestibular schwannoma.
Continuous intraoperative neurophysiological monitoring of cranial nerves V, VI, VII, X, XI, and evoked potentials.
Near-total resection (∼99%) with preservation of the facial nerve.

Main Results:

Near-total resection of the vestibular schwannoma was achieved.
Transient House-Brackmann grade 2 facial palsy improved to grade 1 within 5 weeks.
No nodular enhancement was observed on follow-up MRI, indicating successful resection.

Conclusions:

The translabyrinthine approach is advantageous for large vestibular schwannomas, offering direct exposure and minimal brainstem retraction.
This surgical technique can achieve near-total resection while maximizing functional preservation.
The video serves as a valuable educational tool for understanding the nuances of vestibular schwannoma resection.