Transcanal Transpromontorial Excision of Acoustic Neuroma

By June 7, 2019

Eid, Waleed1; Naguib, Ahmed2
1 Department of ORL-Head and Neck Surgery, Faculty of Medicine, Mansoura University-Egypt;
2 Department of Neurosurgery, Faculty of Medicine, Mansoura University-Egypt.

The management of cases with vestibular schwanoma is a confusing and debatable issue. It swings between the conservative lines as wait and see policy and the gamma knife reaching the surgical procedures with different approaches. Almost surgical approaches are with high risk of great morbidity. The Transcanal transpromontorial approach offers us a direct way to reach the tumor and remove it unless it is not beyond Koos 2.

The video is demonstrating the removal of a Koos 2 vestibular schwanoma (19/14/12 mm) in a 49 years old female patient via transcanal transpromontorial approach through a simple postauricular incision. The patient complained of progressive hearing loss with tinnitus 2 years ago. From the start, the diagnosis was small acoustic neuroma depending on the audiological evaluation and MRI on CPA. The patient choice was wait and see policy with follow up audiological and radiological. The sequential MRIs revealed the growth of the tumor with increasing the severity of SNHL with very poor discrimination.The patient was counseled about the transcanal transpromontorial approach. The operation eas performed via a simple postauricular incision.At the end of the procedure occlusion of the defect by temporalis fascia graft, surgicel, platelet rich plasma and a fat plug then cul-de-sac was performed. The patient suffered from immediate post operative facial paralysis (HB 3) that almost improved 4 months postoperative.

The transcanal transpromontorial approach is a simple, direct and safe way that is suitable for non serviceable hearing ear.

The previous approach is a magnificant one for selected cases.