Nishanta B Baidya1, Moncef Berhouma1, Mario Ammirati2. 1. Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, USA. 2. Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, USA. Electronic address: mario.ammirati@osumc.edu.
Abstract
OBJECTIVE: To demonstrate a flexible endoscope assisted technique to perform microsurgical resection using a retrosigmoid approach of an artificial polymer tumor model that mimics a medium size (15-20mm diameter) vestibular schwannoma. METHODS: Twelve bilateral retrosigmoid dissections were performed in 6 glutaraldehyde embalmed, colored silicone injected, adult cadaveric heads. Using a standard retrosigmoid approach, we first implanted the tumor model at the cerebellopontine angle (CPA) and then we resected the tumor under simultaneous endoscopic and microscopic visualizations. The resection was performed by first creating a corridor by removing the lower portion of the tumor and then by inserting through the same corridor the flexible endoscope mounted on a surgical instrument in order to accomplish early visualization of the VII-VIII complex. This early visualization of the VII-VIII complex made possible expeditious removal of the model with preservation of the VII-VIII complex. RESULTS: We were able to successfully implant the artificial tumor in all the specimens. The post-tumor implantation CT scan confirmed the optimal CPA location of the model with its intra-porus extension. The exposure of the facial and the adjoining neuro-vascular structures was excellent during all stages of the surgical removal and was accomplished with minimal cerebellar retraction, under intermittent endoscopic-assisted control. Early visualization of the facial and vestibular cochlear nerves complex led to unhindered removal of the tumor model. CONCLUSIONS: The endoscopic-assisted microsurgical removal of a tumor model simulating a medium size vestibular schwannoma was feasible in our tumor model study emulating real surgery. Visualization of the acousticofacial bundle at the early stage of the surgical removal should theoretically decrease the risk of its inadvertent injuries as well as facilitate complete removal of the tumor. Clinical studies to validate this laboratory study are necessary.
OBJECTIVE: To demonstrate a flexible endoscope assisted technique to perform microsurgical resection using a retrosigmoid approach of an artificial polymertumor model that mimics a medium size (15-20mm diameter) vestibular schwannoma. METHODS: Twelve bilateral retrosigmoid dissections were performed in 6 glutaraldehyde embalmed, colored silicone injected, adult cadaveric heads. Using a standard retrosigmoid approach, we first implanted the tumor model at the cerebellopontine angle (CPA) and then we resected the tumor under simultaneous endoscopic and microscopic visualizations. The resection was performed by first creating a corridor by removing the lower portion of the tumor and then by inserting through the same corridor the flexible endoscope mounted on a surgical instrument in order to accomplish early visualization of the VII-VIII complex. This early visualization of the VII-VIII complex made possible expeditious removal of the model with preservation of the VII-VIII complex. RESULTS: We were able to successfully implant the artificial tumor in all the specimens. The post-tumor implantation CT scan confirmed the optimal CPA location of the model with its intra-porus extension. The exposure of the facial and the adjoining neuro-vascular structures was excellent during all stages of the surgical removal and was accomplished with minimal cerebellar retraction, under intermittent endoscopic-assisted control. Early visualization of the facial and vestibular cochlear nerves complex led to unhindered removal of the tumor model. CONCLUSIONS: The endoscopic-assisted microsurgical removal of a tumor model simulating a medium size vestibular schwannoma was feasible in our tumor model study emulating real surgery. Visualization of the acousticofacial bundle at the early stage of the surgical removal should theoretically decrease the risk of its inadvertent injuries as well as facilitate complete removal of the tumor. Clinical studies to validate this laboratory study are necessary.