Simultaneous Translabyrinthine Vestibular Schwannoma removal and Cochlear implantation

Simultaneous Translabyrinthine Vestibular Schwannoma removal and Cochlear implantation in small tumor using CI632 device

Endoscopic Transcanal Transpromontorial Removal of an Intracochlear Schwannoma and Traditional Cochlear Implantation

Vestibular schwannomas (acoustic neuromas) develop due to mutations in Schwann cells that cause uncontrolled cell division. As a result, a tumor forms. As these tumors grow, they can compress the cochlear nerve causing unilateral hearing loss and tinnitus. Vestibular schwannomas may cause imbalance and occasionally vertigo. Intralabyrinthine schwannomas account for about 10% of vestibular schwannomas in centers that specialize in temporal bone imaging. Intracochlear schwannomas are the most common type of intralabyrinthine schwannomas. In this video, we describe an endoscopic transcanal transpromontorial approach to intracochlear schwannoma removal.

This surgery was performed by James Prueter, DO, of Southwest Ohio ENT Specialists in Dayton, OH.

Video editing was performed by Austin Miller, OMS-II, Ohio University Heritage College of Osteopathic Medicine.

Cholesterol Granuloma Petrous Apex Revision

Contributors: Ravi N. Samy, M.D., F.A.C.S (University of Cincinnati / CCHMC) and  Shawn Stevens, M.D.

Cholesterol granuloma recurrence at the petrous apex.   The patient had a prior surgery performed without stenting. Revision surgery at UC performed with double-barrel stent placement.

External Related Links: www.cisurgeon.org    www.youtube.com/user/cisurgeon

DOI: http://dx.doi.org/10.17797/vvmrb6t77g

Editor Recruited By: Ravi N. Samy, MD, FACS

Middle Fossa Transventricular and Subtemporal Approach for Meningioma Resection

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.

DOI: https://doi.org/10.17797/nbtj2jdx6l

Lateral Temporal Bone Resection

Contributors: Paul W. Gidley, MD

This video demonstrates the basic steps of lateral temporal bone resection for cancers involving the ear canal.  The lateral temporal bone resection removes the ear canal en bloc, preserving the facial nerve and stapes.

DOI: http://dx.doi.org/10.17797/mn4edyy57u

Editor Recruited By: Ravi N. Samy, MD, FACS

Transcanal Endoscopic Infracochlear Approach for a Petrous Apex Cholesterol Granuloma

This video demonstrates a transcanal endoscopic infracochlear approach to the petrous apex in a patient with a large cholesterol granuloma. The patient presented with a history of profound left sensorineural hearing loss, hemifacial spasm, and House Brackmann Grade 2 facial function. Preoperative imaging demonstrated a T1 and T2 hyperintense heterogenous lesion in both petrous apices with the left being larger than the right on magentic resonance imaging. A computed tomography scan (CT) of the temporal bones demonstrates extension of the left petrous apex lesion into the internal auditory canal and cochlea.

Dr. Isaacson has had 2 patients who have had significant recovery of their bone line after using an infracochlear approach. In the unlikely event that the patient experiences hearing loss in the other ear, their cochlea is preserved for a possible CI. However, the patients hearing loss is likely secondary to the 8th nerve involvement of cholesterol granuloma erosion into IAC.

The patient in this surgical video has been monitored for a year. One year postop CT shows aeration of the apex. This patient’s facial spasm has resolved. Dr. Isaacson has used stents in the past, but in this case felt the opening was large enough that he could forego it. Patient did not recover their hearing.

DOI: http://dx.doi.org/10.17797/1wq11j68wa

Use of CO2 laser in preparation for cochlear implant via round window

Use of CO2 laser in preparation for cochlear implant via round window

Microvascular Decompression for Trigeminal Neuralgia (combined venous & arterial)

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.

DOI: https://doi.org/10.17797/qgthi9k07c

Microsurgical resection of an acoustic neuroma via the translabyrinthine approach

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

Microvascular Decompression for Trigmeminal Neuralgia (venous)

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.

DOI# http://dx.doi.org/10.17797//henaevqy2g

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