2026 Poster Presentations
P344: LONG-TERM RESULTS AND TECHNOLOGY-ASSISTED PRESIGMOID RETROLABYRINTHINE APPROACH FOR THE TREATMENT OF VESTIBULAR SCHWANNOMAS: OUR EXPERIENCE
Federica Gobbi, MD1; Marina Di Marcello, MD1; Denis Aiudi, MD1; Mario Chiapponi, MD1; Ruggero Antonini, MD1; Maurizio Gladi, MD1; Ali Sanad Khalil Saaed, MD2; Maurizio Iacoangeli, Prof, MD1; 1Departement of Neurosurgery, Marche University Hospital, Ancona, Italy; 2Department of Neurosurgery, Al-Galaa Trauma Hospital, Benghazi, Libya
Introduction: Treatment of vestibular schwannomas presents many controversial aspects, starting from the surgical indication to the selection of the best surgical approach. Microsurgery has to be competitive with radiosurgery to providing the best chances of function preservation and complete tumor removal. The two most commonly used surgical approaches are: retrosigmoid suboccipital and presigmoid translabyrinthine. We report our long-term experience by using the endoscopy-assisted presigmoid retrolabyrinthine approach (EAPRA) and the recent technical adjunct: exoscope and piezosurgery.
Methods: We selected 30 patients affected by large sporadic vestibular schwannomas (max diameter >3 cm) surgically treated by EAPRA. Exoscope-assisted approach was used in 3 cases and in 10 patients “cosmetic” mastoidectomy and craniotomy was performed with the use of piezo-electric device.
Results: In 26 out of 30 patients was achieved a complete tumor resection. In 2 cases was observed post-operative transient facial nerve function impairment or worsening, and hearing deterioration in only 1 patient. No threatening complications occurred after surgery, and the length of hospitalization was usually less than 7 days. In the patients treated by using the exoscope a complete resection of the schwannoma was obtained in 2, without any additional complications or limitations in the maneuverability, but the exoscope not replacing the enlargement and the possibility “to look around the corner” provided by the endoscopic view.
Conclusions: The EAPRA can potentially provide a major and more direct, lateral to medial working angle, approach to the anatomical region of interest and internal acoustic meatus, direct access to the cerebello-pontine angle along with labyrinthine complex preservation, conserving hearing function and, allowing a potentially minimal cerebellar retraction. Endoscopic assistance is a crucial adjunct in the presigmoid retrolabyrinthine approach because it ensures complete visualization of the intracanalicular portion of the schwannoma. In our experience, also the use of the exoscope can help in improving visualization of the surgical field. The application of piezoelectric drill to craniotomies bordering or involving the sinuses appeared safe and also improved a cosmetic and functional reconstruction.