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.
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: 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
Editor Recruited By: Ravi N. 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:Michael Golinko, MD, MA, Eylem Ocal, MD and Kumar Patel, PA
Premature metopic suture fusion is corrected using fronto-orbital advancement and cranial vault remodeling to open the fused suture and allow for adequate brain growth.
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