Abstract
Vestibular schwannomas are benign tumors of the vestibular division of the eighth cranial nerve, with an incidence of 1 to 2 per 100,000 annually. Large tumors (>3 cm) may cause disabling symptoms such as progressive hearing loss, vestibulopathy, or trigeminal nerve dysfunction, often necessitating microsurgical resection. This video demonstrates the translabyrinthine resection of a 3.2-cm left-sided vestibular schwannoma in a 67-year-old woman with worsening sensorineural hearing loss and new-onset lip numbness ( Video 1 ). The procedure was performed at a tertiary center with continuous intraoperative neurophysiological monitoring of cranial nerves V, VI, VII, X, and XI, as well as somatosensory and motor evoked potentials. Near-total resection (∼99%) was achieved, with a small residual adherent to the cisternal segment of the facial nerve near the superior petrosal vein to maximize functional preservation. Postoperatively, the patient experienced transient House–Brackmann (HB) grade 2 facial palsy, which improved within 5 weeks to HB 1, and no nodular enhancement was observed on follow-up magnetic resonance imaging. The translabyrinthine approach provides direct exposure of the internal auditory canal with minimal brainstem retraction, making it particularly advantageous for large tumors in patients with nonserviceable hearing. Beyond its operative illustration, this video emphasizes step-by-step surgical anatomy, technique, and intraoperative decision-making, offering neurosurgery residents an educational framework for understanding indications, technical nuances, and complication avoidance strategies.
Keywords: vestibular schwannoma, translabyrinthine approach, facial nerve preservation, skull base surgery, intraoperative monitoring
Video 1 Translabyrinthine Approach for Vestibular Schwannoma.
Conflict of Interest The authors declare that they have no conflict of interest.
Authors' Contributions
Conception and design: B.G., X.Z., J.A.Z., A.G.B., C.S.G. Acquisition of data: B.G., X.Z., J.A.Z. Analysis and interpretation of data: B.G. Drafting the article: B.G., X.Z. Critically revising the article: B.G., X.Z., J.A.Z., A.G.B., C.S.G. Reviewed submitted version of manuscript: B.G., X.Z., J.A.Z., A.G.B., C.S.G. Study supervision: C.S.G., A.G.B. Approved the final version of the manuscript on behalf of all authors: C.S.G.
Ethical Approval
The patient provided informed consent for surgery and publication. In accordance with institutional policy, this study was determined to be exempt from Institutional Review Board oversight at the University of Oklahoma.
Suggested Readings
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