Hearing preservation/rehabilitation surgery for small vestibular schwannoma: preliminary experience with the presigmoid retrolabyrinthine approach

Abstract

Background

The presigmoid retrolabyrinthine approach (PRA) for small vestibular schwannoma (VS) has unique advantages. Combination with partial labyrinthectomy further makes up its defect of high demand for anatomy.

Objective

Aimed to describe our use of the PRA with partial labyrinthectomy in VS surgery.

Methods

We retrospectively analyzed 10 patients diagnosed with VS who underwent PRA between September 2017 and November 2020. Their perioperative data were analyzed.

Results

Six tumors were on the left and three were on the right. One case was due to neurofibromatosis type 2 with bilateral involvement and underwent internal auditory canal decompression by PRA without tumor removal; all other patients underwent total tumor resection. Four patients underwent cochlear implantation simultaneously because of hearing loss that was detected during surgery. Three patients underwent partial labyrinthectomy. Five patients achieved hearing preservation, and one experienced hearing improvement. One of the three patients who underwent partial labyrinthectomy maintained hearing. All patients’ pre- and postoperative facial nerve functions were House-Brackmann grade I. After a median follow-up time of 13 months, no tumors recurred.

Conclusions

PRA for small VS is a safe and effective surgery that can achieve facial nerve and hearing preservation. Combination with partial labyrinthectomy can also preserve hearing.

Chinese abstract

背景：对于小前庭神经鞘瘤（VS）, 前乙状后迷路疗法（PRA）具有独特的优势。与迷路部分切除术的结合进一步弥补了其对解剖学的高要求的缺陷。

目的：描述将PRA与迷路部分切除术相结合在VS手术中的应用。

方法：我们回顾性分析了2017年9月至2020年11月期间接受PRA的10例经确诊为VS的患者, 并分析了他们手术期前后的资料。

结果：6个肿瘤位于左侧, 3个肿瘤位于右侧。 1例由于2型神经纤维瘤病伴双侧受累, 通过PRA进行了内耳道减压, 但未切除肿瘤。所有其他患者均行肿瘤全切除术。由于手术期间发现听力下降, 四名患者同时接受了人工耳蜗植入。三名患者接受了迷路部分切除术。五名患者实现了听力保护, 其中一名经历了听力改善。接受部分迷路切除术的三名患者之一保持听力。所有患者术前和术后的面神经功能均为House-Brackmann I级。中位随访时间13个月后, 未见肿瘤复发。

结论：PRA对于小型VS是一种安全有效的手术, 可以实现面神经和听力的保护。结合迷路切除术还可以保持听力。

Keywords:

• Presigmoid retrolabyrinthine approach
• vestibular schwannoma
• partial labyrinthectomy
• hearing preservation

Acknowledgments

We would like to thank Wiley Editing Services for English language editing of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Yongxin Li received grant from National Natural Science Foundation of China [grant no. 81870716] and Xingmei Wei received grant from Beijing Tongren Hospital [grant no.2020-YJJ-ZZL-032].