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The Extra-Extended Translabyrinthine Approach for Resection of Large Acoustic Neuroma: 2-Dimensional Operative Video.
Pacheco Junior, Messias Gonçalves; Hahn, Yoav; Hazin, Gabriela Falcão; Caldas Neto, Silvio; Leal, Mariana de Carvalho; Figueiredo, Eberval Gadelha; Vidal, Claudio H F; Coimbra, Caetano José Porto.
Afiliação
  • Pacheco Junior MG; Unit of Neurosurgery, Santa Casa de Paranavaí, Paraná, Brazil.
  • Hahn Y; Department of Neurosurgery, Postgraduate Program in Neurology-FMUSP, São Paulo, Brazil.
  • Hazin GF; Skull Base Surgery Center, Baylor University Medical Center, Dallas, Texas, USA.
  • Caldas Neto S; Minimally Invasive Brain Surgery Center, Medical City Hospital, Dallas, Texas, USA.
  • Leal MC; Pernambuco College of Health, Recife, Brazil.
  • Figueiredo EG; Department of Otolaryngology, Health Science Center, Federal University of Pernambuco, Recife, Brazil.
  • Vidal CHF; Department of Otolaryngology, Health Science Center, Federal University of Pernambuco, Recife, Brazil.
  • Coimbra CJP; Department of Neurosurgery, University of São Paulo, São Paulo, Brazil.
Article em En | MEDLINE | ID: mdl-38888316
ABSTRACT
The extended translabyrinthine approach to acoustic neuroma (AN) was created to allow improved visualization and access to larger tumors.1,2 The dural opening, however, remained confined to the presigmoid space. Other authors have introduced modifications to increase the dura exposure around the internal auditory canal (IAC).3-5 The extra-extended translabyrinthine approach was conceptualized by the senior author (CC) to maximize AN exposure and early cranial nerve identification. The tentorial peeling was added to allow extradural mobilization of the temporal lobe.6 This allows further safe bone removal around the IAC and petrous apex and consistent opening of the facial canal at IAC fundus. This modification creates 280-to-360-degree dura exposure at the IAC. The dural opening extends to the petrous apex superiorly and the prepontine arachnoid cistern inferiorly and includes resection of a tentorium dural flap created by the tentorial peeling.6 This exposure allows for near circumferential exposure of the tumor and early identification of the glossopharyngeal nerve in the cochlear aqueduct area, the trigeminal nerve at the porus trigeminal, and the facial nerve (FN) at IAC fundus. In addition, this ample exposure permits identification of the FN trajectory in the tumor capsule before any tumor dissection. We present a detailed video of extra-extended translabyrinthine approach technique in a patient with a large left AN (Hannover classification T4B).7 This video does not involve any human research projects not requiring Institutional Review Board/ethic committee approval. The patient consented to the procedure and to the publication of his image. Complete resection was obtained. The FN function was House-Brackman I/VI.

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Oper Neurosurg (Hagerstown) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Oper Neurosurg (Hagerstown) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos