The Clinical Usefulness of Translabyrinthine Approach for Removal of the Vestibular Schwannomas.

Kim, Jong Hyun; Cho, Tae Goo; Park, Kwan; Park, Ik Seong; Nam, Do Hyun; Lee, Jung Il; Cho, Yang Sun; Hong, Sung Hwa; Hong, Seung Chyul; Shin, Hyung Jin; Eoh, Whan

Original Article

Journal of Korean Neurosurgical Society 2001;30(6): 755-760.

Jong Hyun Kim, Tae Goo Cho, Kwan Park, Ik Seong Park, Do Hyun Nam, Jung Il Lee, Yang Sun Cho, Sung Hwa Hong, Seung Chyul Hong, Hyung Jin Shin, Whan Eoh

¹Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
²Department of Otorhinolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

OBJECTIVE
To determine the feasibility of translabyrinthine approach in the vestibular schwannoma patients, the authors reviewed eighteen consecutive cases, focusing at their functional outcome and operative complications. MATERIALS AND METHOD: To evaluate the functional outcome, we reviewed preoperative radiological findings such as size of tumors and location of jugular bulb as well as the preoperative neurological status including audiometric analysis and cranial nerve function in 18 patients, diagnosed as vestibular schwannoma. Also the surgical outcome was evaluated according to the functional preservation of facial nerve and incidence of the surgical complication as well as the extent of surgical resection.
RESULTS
The age of patients ranged from 21 to 62 years, with a mean of 50 years. Of 18 patients operated in our center by the translabyrinthine approach, wide exposure with total removal of the mass was possible in 16 cases (88.8%). The facial nerve was anatomically preserved in 88.8%. At six-month follow-up, facial nerve function was good(Grade I-II) in 15 patients(83%) and acceptable(I-IV) in all patients. Although the jugular bulb was highly placed is five patients, gross total resection was possible without facial nerve injury in all patients by the translabyrinthine approach. One patient experienced CSF leakage after surgery, but there was no patient with disabling deficit.
CONCLUSION
Use of the translabyrinthine approach for removal of vestibular schwannomas resulted in good anatomical and functional preservation of the facial nerve, with minimal incidence of morbidity and no mortality. In cases of high jugular bulb impacted into mastoid bone, total removal was possible by displacing the jugular bulb with Surgicel cellulose and placement of bone wax.

Key Words: Vestibular schwannoma; Translabyrinthine approach; High jugular bulb; Facial nerve