Name:
Diamond knife dissection technique for nerve preservation during resection of large vestibular schwannomas
Description:
Diamond knife dissection technique for nerve preservation during resection of large vestibular schwannomas
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/6b335f3f-b53f-40e7-b877-d791b277afb2/videoscrubberimages/Scrubber_398.jpg
Duration:
T00H08M12S
Embed URL:
https://stream.cadmore.media/player/6b335f3f-b53f-40e7-b877-d791b277afb2
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/6b335f3f-b53f-40e7-b877-d791b277afb2/21-104.mp4?sv=2019-02-02&sr=c&sig=c4ASP3v7RWyo0i8%2Bp6ZAIBfTqbGQIQutHPgZCk7c18U%3D&st=2024-11-23T12%3A58%3A26Z&se=2024-11-23T15%3A03%3A26Z&sp=r
Upload Date:
2021-10-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER 1: This is Dr. Karl Roessler. And herein, I will demonstrate a microsurgical resection of a 2.6-cm vestibular schwannoma using a diamond knife for a dissection with the goal of preserving facial nerve function and hearing. To the best of our knowledge, this is the first such video to demonstrate the use of this technique for vestibular schwannoma resection. The patient is a 27-year-old male who presented with left-sided hearing loss, tinnitus, loss of balance, and dizziness.
SPEAKER 1: Neurological examination was nonfocal without any additional neurological deficits. MRI scan show a classic "ice cream on cone" vestibular schwannoma measuring 26 mm in diameter in the left cerebellopontine angle extending into the left internal acoustic meatus. The patient was positioned semisitting with concurrent intraoperative monitoring, using continuous facial nerve electromyography in brainstem auditory evoked potentials.
SPEAKER 1: Additionally, the patient was continuously monitored with intraoperative transesophageal echocardiography to detect and prevent any venous air embolism. After retrosigmoidal craniotomy and dural opening, the cerebellum was gently retracted, and the CPA was exposed. Then drilling of posterior wall of the internal auditory canal was performed using a 2- mm diamond drill.
SPEAKER 1: Initially, the tumor was divulged using the ultrasonic surgical aspirator. The facial nerve is identified by stimulation. Consequently, the intrameatal tumor portion was inoculated by using a plate knife.
SPEAKER 1: After that, the diamond knife was inserted to detach the cochlear nerve from the tumor capsule. Again, the facial nerve is identified in the brainstem by electrophysiological stimulation. After identifying the facial nerve by electric stimulation, the nerve was gently dissected from the tumor by dividing the arachnoidal membrane between the nerve and the tumor capsule, using the diamond knife.
SPEAKER 1: This worked perfectly well by using the sharp diamond knife, which precisely allowed that dissection of the nerve fibers and minimized damaging to the nerve. With the same technique, it was possible to complete that dissection of the tumor on the meatal part of the facial nerve, avoiding any hazardous maneuver to the nerve.
SPEAKER 1:
SPEAKER 1: Finally, the remaining part of the tumor was detached by using the micro-scissors. The cochlear nerve was inspected and covered with Surgicel.
SPEAKER 1: The completely tumor-free, facial nerve is covered with calcium antagonist soaked Gelfoam. After tumor removal, every muscle graft and fibrin sealant were applied to clot any opened air cells at the internal auditory canal and to prevent risk of postoperative CSF leakage.
SPEAKER 1: Dural closure was then performed in a multilayer watertight fashion. A PMMA cranioplasty was used to replace the bone and held with screwed titanium plates, following layer-by- layer closure of muscle. and skin. The extubation was performed immediately after surgery. And the patient woke up without any neurologic deficits, despite reduced hearing on the tumor side.
SPEAKER 1: Postoperative audiogram below shows useful hearing preserved. This is his postoperative MRI, which demonstrates complete tumor resection. Postoperatively, the patient was neurologically intact, had no facial palsy, and still useful hearing on his left ear. And he was discharged at home after 1 week.
