Translabyrinthine approach for vestibular schwannoma
Although the translabyrinthine approach was described by Panse in 1904 and first used to resect a cerebellopontine angle tumor by Quix in 1912, it was not until House published 47 resections with no mortalities in 1964 that the approach was truly popularized 1).
Since that time it has been well described in the literature as a useful approach for resection of vestibular schwannomas in cases where hearing preservation is not a concern. Additionally Morrison and King have described a modified use of this approach in combination with a transtentorial component for the resection of vestibular schwannomas and other lesions of the cerebellopontine angle and proximate anatomy 2).
Surgical series of translabyrinthine resections often include cerebellopontine angle meningiomas of the as well as the internal acoustic meatus, schwannomas of the facial and trigeminal nerves, and cholesteatomas, neurinomas, and chordomas – illustrating the multiple uses of this approach 3).
With the help of an endoscope, Sun et al exposed the internal auditory canal and cerebellopontine through a translabyrinthine approach and the inferior colliculus through a keyhole subtemporal approach. This double approach can be combined to expose the internal auditory canal and cerebellopontine angle and inferior colliculus satisfactorily in the same surgical setting. This combined approach can avoid retraction of the cerebellum and reduce serious adverse events and complications 4).
Case series
Case reports
A healthy 59-year-old male with a unilateral sporadic vestibular schwannoma.
The patient elected to undergo a translabyrinthine approach for resection of a vestibular schwannoma. An aberrant loop of AICA was encountered during the temporal bone dissection within the petrous portion of the temporal bone.
The patient suffered a presumed ischemic insult resulting in a fluctuating ipsilateral facial paresis and atypical postoperative nystagmus.
MRI demonstrated an ischemic lesion in the vascular distribution of the right anterior-inferior cerebellar artery, including the lateral portion of the right cerebellar hemisphere, middle cerebellar peduncle, and bordering the right cranial nerve VII nucleus. His functional recovery was excellent, essentially identical to the anticipated course in an otherwise uncomplicated surgery.
This case highlights the irregular anatomy of the AICA as well as the importance of thorough neurological exams in the postsurgical lateral skull base patient 5).