Removal of vestibular schwannoma with significant intrameatal extension by translaby rinth ine approach. Case report

Vestibular schwannomas are common CNS tumors and one of the most often tumors, localized in posterior fossa. Despite their benign nature, treatment of vestibular schwannomas is challenging due to high frequency of complications, especially cranial nerves palsy. Microsurgical removal is main treatment option, but several approaches could be used for surgery, each differ from another by frequency and type of complications. Present paper includes case report of vestibular schwannoma removal through translabyrinthine approach, pros and contras discussed and brief literature review given.
Materials and methods. A case report of medium size vestibular schwannoma — up to 12 mm in diameter (II stage Koos, T2 Samii) with significant intrameatal extension. Symptoms are headache, peripheral vertigo. The patients feature is complete left-sided hearing loss after acoustic trauma. Tumor removal through translabyrinthine approach performed. During preoperational examination head CT with assessment of individual anatomy of pyramid, mastoid, jugular vein and sigmoid sinus performed. Extent of resection assessed by contrast-enhanced MRI a day after surgery. Follow up at time of paper submission — 6 months.
Results. Total tumor removal performed. At the earlier postop period moderate VII nerve palsy (III Brakmann, III FNGS2.0) developed, but declined to II 14 days after and completely regressed after 6 months of treatment. No other deficit identified. Subaponeurotic CSF collection disappeared by itself.
Conclusion. For selected patients translabyrinthine approach become real alternative to retrosigmoid in vestibular schwannoma surgery.

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