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.
Gavriel D. Kohlberg, MD – University of Cincinnati
Noga Lipschitz, MD – University of Cincinnati
Charlie Poff, BS – Medical University of South Carolina
Ravi N. Samy, MD, FACS – University of Cincinnati
A 31 year-old male presented with diplopia and was found to have left sixth nerve palsy on physical examination. Work-up with MRI revealed a hypointense mass on T2 images involving the mid to lower clivus with penetration of the posterior fossa dura. The patient had no complaints of nasal obstruction, no prior nasal surgery or nasal trauma. Intraoperative frozen section analysis revealed chordoma.
Author Note: minute 3:41 “rostrum” was spelled incorrectly.
A 51 year-old male presented to an outside otolaryngologist with recurrent facial pain and congestion. He was found to have a left-sided nasal mass. A work-up was performed, complete with biopsy, which was diagnosed as non-intestinal type adenocarcinoma. He underwent resection via the endoscopic endonasal transcribriform approach. In this video publication, we present our preferred method of reconstruction for sinonasal malignancies treated by endoscopic transcribriform resection using a multilayered closure with the following: a subdural DuraGen inlay graft, a fascia lata onlay graft, and an extradural, extracranial onlay pericranial flap via nasionectomy. A lumbar drain was placed at the end of the case for CSF diversion until the fifth postoperative day.
Paul A. Gardner, MD, Eric W. Wang, MD, Juan C. Fernandez-Miranda, MD, and Carl H. Snyderman, MD, MBA
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