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Transotic Approach for Cochlear Schwannoma

This video shows a transotic approach for a cochlear schwannoma in a 59-year-old female who presented with sudden sensorineural hearing loss in her left three years prior. She was found to have subsequent growth of her tumor on imaging and elected to undergo surgery. The transotic approach is a valuable approach within the armamentarium of a skull base team and differs from the transcochlear approach in the handling of the facial nerve. Techniques for ear canal overclosure, eustachian tube packing and mastoid obliteration are also highlighted.

Transotic approach, modified rambo ear canal overclosure, mastoid obliteration
Access to the lateral skull base
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CT temporal bone, MRI IAC with contrast
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1. Browne JD, Fisch U. Transotic approach to the cerebellopontine angle. 1992. Neurosurg Clin N Am. 2008 Apr;19(2):265-78, vi. 2. Brackmann DE, Green JD Jr. Translabyrinthine approach for acoustic tumor removal. 1992. Neurosurg Clin N Am. 2008 Apr;19(2):251-64, vi. 3. Gantz BJ, Fisch U. Modified transotic approach to the cerebellopontile angle. Arch Otolaryngol. 1983 Apr;109(4):252-6. 4. Wick CC, Moore AM, Killeen DE, Isaacson B. The Modified Rambo Transcanal Approach for Cochlear Implantation in CHARGE Syndrome. Otol Neurotol. 2017 Oct;38(9):1268-1272. 5. Hunter JB, Sweeney AD, Carlson ML, Wanna GB, Rivas A, Weaver KD, Chambless LB, Thompson RS, Haynes DS, Bennett ML. Prevention of Postoperative Cerebrospinal Fluid Leaks After Translabyrinthine Tumor Resection With Resorbable Mesh Cranioplasty. Otol Neurotol. 2015 Sep;36(9):1537-42.

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