Microsurgical Gross Total Resection of an Intracanalicular-Cisternal (Koos-4) Vestibular Schwannoma via a Retrosigmoid Approach with Intraoperative Endoscopic Assistance

World Neurosurg. 2022 Feb:158:225. doi: 10.1016/j.wneu.2021.11.110. Epub 2021 Dec 3.

Abstract

We present the case of a 23-year-old female with a history of progressive hearing loss in the left ear, dizziness, and vertigo. Magnetic resonance imaging demonstrated a left mass extending from the internal auditory canal into the cerebellopontine angle (Koos-4).1 A retrosigmoid approach assisted with a microinspection tool was chosen.2-5 Microsurgical near total resection was achieved. The patient presented a postoperative facial deficit (House-Brackman grade 2 postoperative), with complete resolution after 2 months. Video 1 highlights the critical steps of the retrosigmoid approach and the benefit of using the microinspection tool for vestibular schwannoma resection.

Keywords: Posterior fossa; Translabyrinthine approach; Vestibular schwannoma.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Adult
  • Cerebellopontine Angle / diagnostic imaging
  • Cerebellopontine Angle / pathology
  • Cerebellopontine Angle / surgery
  • Ear, Inner* / surgery
  • Endoscopy / methods
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Neuroma, Acoustic* / complications
  • Neuroma, Acoustic* / diagnostic imaging
  • Neuroma, Acoustic* / surgery
  • Young Adult