Name:
10.3171/2022.1.FOCVID21258
Description:
10.3171/2022.1.FOCVID21258
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/7eaf9704-731b-41d9-a2c3-700b9c314942/videoscrubberimages/Scrubber_75.jpg
Duration:
T00H05M09S
Embed URL:
https://stream.cadmore.media/player/7eaf9704-731b-41d9-a2c3-700b9c314942
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/7eaf9704-731b-41d9-a2c3-700b9c314942/21-258.mp4?sv=2019-02-02&sr=c&sig=%2FOJvhzl1nD5Oliv1gLF7CDSaTpeUpW3c0CBaXnQN1hI%3D&st=2024-05-03T07%3A27%3A32Z&se=2024-05-03T09%3A32%3A32Z&sp=r
Upload Date:
2022-02-10T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER 1: This is an interesting case of a 69-year-old woman who presented with refractory left facial pain and a subtle left hearing loss. She had two lesions, one, a petrous apex meningioma, extending into Meckel's cave. And the second, an intracanalicular Koos grade I vestibular schwannoma. Given the fact that both of these lesions were symptomatic, we'll perform a single approach for removal of both tumors.
SPEAKER 1: We'll perform a hearing preservation operation through a middle fossa approach and an anterior petrosectomy to remove the meningioma. She's positioned in the lateral position. And her head is placed in a Mayfield head holder. The reverse question mark incision is placed. We'll lift off a 4 × 4– cm bone flap, centered on the root of the zygoma, and identify the stratum spinosum and ligate the middle meningeal artery.
SPEAKER 1: We'll continue our extradural dissection and identify the arcuate eminence and the greater superficial petrosal nerve. We'll proceed with drilling of the internal auditory canal through a middle fossa approach. The canal is identified here, and the dura is preserved. We'll perform a 270-degree drilling of the internal auditory canal to enable resection of the vestibular schwannoma.
SPEAKER 1: The anterior petrosectomy is then performed. We'll continue to drill the anterior petrous bone and remove the petrous apex. The petrous apex is then resected.
SPEAKER 1: We'll then open up the dura over Meckel's cave and identify the root of the fifth nerve. We then open up over the petrous apex and identify the meningioma extending into Meckel's cave. We ensure to remove all the dura of the attachment of the meningioma and then dissect the meningioma through the opening.
SPEAKER 1: The root of the fifth nerve is visualized. After the meningioma is removed, we'll turn our attention to the internal auditory canal and resect the vestibular schwannoma. We'll use auditory brainstem responses for monitoring. The facial nerve is seen here, overlying the region of the tumor. And we'll ensure that we remove enough of the bone to be able to dissect the tumor completely.
SPEAKER 1: We slowly dissect the tumor from the facial nerve and debulk the tumor. The schwannoma is seen here. We define the plane between the nerve and the schwannoma. And then, using our microdissectors, elevate the tumor from the region of the cochlear nerve behind it.
SPEAKER 1: After resection of the vestibular schwannoma, we test the function of the facial nerve and the ABR is preserved. We wax off air cells and place fat with fiber and glue for closure. The bone flap is replaced with a Medpor cranioplasty. The scalp is closed.
SPEAKER 1: The postoperative imaging demonstrates resection of both lesions. Her postop exam was remarkable for a transient left abducens palsy, which resolved over 6 weeks. And her hearing was preserved.