This is a demonstration of the retrosigmoid approach for microsurgical resection of a cerebellopontine angle tumor. Th patient presented with gait disturbance and normal hearing. A suboccipital craniotomy was used for access to the cerebellopontine angle. Using microsurgical technique, the tumor was dissected away from the glossopharyngeal nerve. Pathological analysis confirmed that the tumor was a schwannoma of the glossopharyngeal nerve.
Chiari decompression is a common neurosurgical procedure. Chiari malformations present with a number of symptoms including Valsalva-induced headaches, swallowing dysfunction, and sleep apnea. Chiari malformations can also cause syringomyelia and syringobulbia. Surgical procedures used for the treatment of Chiari malformation include bone-only decompression (posterior fossa craniectomy +/- cervical laminectomy), craniectomy/laminectomy with duraplasty, and craniectomy/laminectomy/duraplasty with shrinkage or resection of the cerebellar tonsils. The procedure used depends on the specifics of the patient’s condition and the preference of the surgeon.
The patient presented here had undergone a prior Chiari decompression at the age of 20 months. This was bone-only with posterior fossa craniectomy and C1-2 laminectomy. The dura was not opened due to the presence of a venous lake. He initially had improvement in his symptoms. However, his headaches and snoring recurred, balance worsened, and dysphagia never improved. Therefore, a repeat Chiari decompression at the age of 28 months was performed as presented here.
Contributors: Daniel Felbaum and H. Jeff Kim
The video demonstrates the resection of a trigeminal schwannoma via a middle fossa craniiotomy and anterior petrosectomy. A large dumbbell-shaped tumor was essentially two tumors in one. The anterior petrosectomy provided access mainly to the posterior component of the tumor, which was compressing the pons, and obscured by the tentorium and petrous ridge. Mobilization of the lateral wall of the cavernous sinus freed the anterior component and thus allowed the removal of the rest of the schwannoma.
Contributors: Micheala Lee
This is a demonstration of using the transventricular and subtemporal corridors for resecting a large middle fossa, tentorial meningioma. The video details the microsurgical technique for detaching the tumor from the tentorial incisura, working near critical structures such as the oculomotor nerve, trochlear nerve, and posterior communiating artery. It also includes precise demonstration of how to separate the massive tumor from the feeding arterial supply stemming from the posterior cerebral artery.
Otosclerosis causes conductive hearing loss with absent acoustic reflexes. Stapedotomy is a successful surgery that is demonstrated in this video.
Editor Recruited By: Ravi Samy, MD, FACS
Contributors: Fadi Sweiss
Microvascular decompression is the most effective surgical procedure for treating trigeminal neuralgia in patients with classic symptoms. Here we present a patient who had a “duo crush” from both a vein, as well as a loop of the superior cerebellar artery. The key maneuvers to create space between the compressive element and the nerve, in order to secure the teflon “cushion,” are highlighted.
Contributors: H. Jeffrey Kim
The translabyrinthine approach has often been reserved for large acoustic neuromas because it requires less retraction on the cerebellum when compared to the retrosigmoid approach for a similar tumor. However, the translabyrinthine approach is equally useful for smaller tumors, when the patients has no residual ipsilateral hearing. It allows for early visualization of the facial nerve, and thus better protection of this crucial nerve.
DOI #: http://dx.doi.org/10.17797/168b12z8m4
Contributors: Daniel R. Felbaum
Microvascular decompression is the most effective surgical procedure for treating trigeminal neuralgia in patients with classic symptoms. The most frequent compressive force is the superior cerebellar artery. Here we demonstrate the procedure in a patient with long-standing, classic symptoms of trigeminal neuralgia, in whom we discovered compression from venous structures.
Contributors: Bruce E. Mickey and J. Walter Kutz
This video highlights key steps to the translabyrinthine approach for vestibular schwannoma resection. It emphases identification of the facial nerve and the benefit of facial nerve monitoring in lateral skull base surgery.
This video demonstrates the operative setup and surgical steps of a middle fossa approach for the resection of vestibular schwannoma (acoustic neuroma).
Cameron C. Wick, MD (email@example.com) 1
Samuel L. Barnett, MD (firstname.lastname@example.org) 2
J. Walter Kutz Jr., MD (email@example.com) 3
Brandon Isaacson, MD (firstname.lastname@example.org) 3
1 – Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO
2 – Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX
3- Department of Otolaryngology – Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX