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Today. Perspectives in Skull Base Surgery Microscopic and Endoscopic Hands-on Course 15th International workshop

Perspectives in Skull Base Surgery Microscopic and Endoscopic Hands-on Course 15th International workshop

November 3 — November 4

Naples, Italy

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Program
Evolving role of the endoscope in skull base surgery
(P. Castelnuovo)
9.20 am Endoscopic anatomy of the midline skull base
(F. Esposito)
9.30 am Computer-based planning of the endoscopic endonasal skull base approaches
(M. De Notaris)
9.40 am The endoscopic endonasal transsphenoidal approach to the sella & its variations
(P. Cappabianca)
10.00 am The endoscopic endonasal approach to the midline anterior cranial base
(L.M. Cavallo)

10.35 am Step by step Hands-on
Endonasal approaches

2.00 am Keynote lecture:
Surgical approaches for craniopharyngiomas
(J. Steno)
2.20 pm Supraorbital approach (microscopic & endoscopic techniques)
(A. Delitala)
2.35 pm Pterional approach & variations
(O. de Divitiis)
2.50 pm Transcallosal approach
(R. Delfini)
3.05 pm Subfrontal approaches
(F. Angileri)

3.35 pm Step by step Hands-on
Transcranial approaches

8.30 am Keynote lecture:
Third ventricle microsurgery
(F. Tomasello)
8.50 am Endoscopic management of intraventricular lesions
(M. Gangemi)
9.05 am Endoscopic endonasal approach to cavernous sinus
(G. Frank, D. Mazzatenta)
9.20 am Endoscopic endonasal approach to Meckel’s cave
(E. Jeanneau)
9.35 am The endoscopic endonasal approach to the clivus
(D. Solari)
9.50 am Endoscopic endonasal cranial base reconstruction techniques
(D. Locatelli)
10.05 am Endoscopic resection of intraparenchimal brain tumors
(S. Cudlip)

10.35 am Step by step Hands-on
Endonasal approaches
1.00 am Lunch
2.00 am Keynote lecture:
Microscopic & endoscopic retrosigmoid approach
(M. Tatagiba)
2.20 pm Patient positioning in skull base surgery
(D. Grujicic)
2.35 pm Subtemporal approach & anterior petrosectomy
(G. Catapano)
2.50 pm Posterior approach to foramen magnum
(F. Maiuri)
3.05 pm Postero-lateral and antero-lateral approach to the foramen magnum
(S. Froelich)
3.20 pm Reconstruction techniques in skull base surgery
(P. De Marinis, P. Caiazzo)
3.35 am Step by step Hands-on
Transcranial approaches

Case of the Month Unilateral Hearing Loss

Unilateral Hearing Loss

History & Examination
30 y/o previously healthy female presents with a 1 year history of progressive left-sided hearing loss and tinnitus.

Her past medical history and surgical history are unremarkable.

Physical examination reveals difficulty with tandem gait and nystagmus, but no dysmetria.

A limited post-contrast study of the IAC and an audiogram are obtained.

Diagnostic Studies
Word recognition scores in the right ear is 100% at 55 dB and 84% at 75 dB

PTA
22 dB (air) and 18 dB (bone) –right
42 dB (air) and 32 dB (bone) – left

Summary -moderate to severe sensorineural hearing loss for the left ear

T1-Weighted with contrast

T2-BFFE

Audiogram

 

Go to the Test

Lateral inferior cerebellar peduncle approach

4 patients (3 woman and 1 man) who had a symptomatic dorsolateral brainstem cavernous malformation with radiographic and clinical evidence of hemorrhage, underwent excision via a far lateral suboccipital craniotomy through the foramen of Luschka and with an incision in the cerebellar peduncle.On intraoperative examination, 2 of the 4 patients had hemosiderin staining on the surface of the peduncle. All lesions were completely excised and all patients had a good or excellent outcome (modified Rankin Scale scores of 0 or 1).

Case series of Deshmuk et al., illustrates that intrinsic lesions of the dorsolateral medulla can be safely removed laterally through the foramen of Luschka and the inferior cerebellar peduncle 1).

1) Deshmukh VR, Rangel-Castilla L, Spetzler RF. Lateral inferior cerebellar peduncle approach to dorsolateral medullary cavernous malformation. J Neurosurg. 2014 Sep;121(3):723-9. doi: 10.3171/2014.5.JNS132276. Epub 2014 Jun 27. PubMed PMID: 24972129.

Management of small vestibular schwannoma: UptoDate

Management of small  vestibular schwannoma consists of 3 options:

Observation with imaging follow-up

Radiosurgery

And/or tumor removal.

Iwao Yamakami et al., report the long-term outcomes and preservation of function after retrosigmoid approach removal and clarify the management paradigm for small tumors.

A total of 44 consecutively enrolled patients with small tumor and preserved hearing underwent retrosigmoid tumor removal in an attempt to preserve hearing and facial function by use of intraoperative auditory monitoring of auditory brainstem responses (ABRs) and cochlear nerve compound action potentials (CNAPs). All patients were younger than 70 years of age, had a small AN (purely intracanalicular/cerebellopontine angle tumor ≤ 15 mm), and had serviceable hearing preoperatively.

According to the American Academy of Otolaryngology Head and Neck Surgery hearing preservation reporting guidelines of the 44 patients were as follows: Class A, 19 patients; Class B, 17; and Class C, 8. The surgical technique for curative tumor removal with preservation of hearing and facial function included sharp dissection and debulking of the tumor, reconstruction of the internal auditory canal, and wide removal of internal auditory canal dura.

For all patients, tumors were totally removed without incidence of facial palsy, death, or other complications. Total tumor removal was confirmed by the first postoperative Gadolinium enhanced MRI performed 12 months after surgery. Postoperative hearing levels were Class A, 5 patients; Class B, 21; Class C, 11; and Class D, 7. Postoperatively, serviceable (Class A, B, or C) and useful (Class A or B) levels of hearing were preserved for 84% and 72% of patients, respectively. Better preoperative hearing resulted in higher rates of postoperative hearing preservation (p = 0.01); preservation rates were 95% among patients with preoperative Class A hearing, 88% among Class B, and 50% among Class C. Reliable monitoring was more frequently provided by CNAPs than by ABRs (66% vs 32%, p < 0.01), and consistently reliable auditory monitoring was significantly associated with better rates of preservation of useful hearing. Long-term follow-up by MRI with Gd administration (81 ± 43 months [range 5-181 months]; median 7 years) showed no tumor recurrence, and although the preserved hearing declined minimally over the long-term postoperative follow-up period (from 39 ± 15 dB to 45 ± 11 dB in 5.1 ± 3.1 years), 80% of useful hearing and 100% of serviceable hearing remained at the same level.

As a result of a surgical technique that involved sharp dissection and internal auditory canal reconstruction with intraoperative auditory monitoring, retrosigmoid removal of small ANs can lead to successful curative tumor removal without long-term recurrence and with excellent functional outcome. Thus, Yamakami et al., suggest that tumor removal should be the first-line management strategy for younger patients with small tumor and preserved hearing 1).

1) Yamakami I, Ito S, Higuchi Y. Retrosigmoid removal of small acoustic neuroma: curative tumor removal with preservation of function. J Neurosurg. 2014 Sep;121(3):554-63. doi: 10.3171/2014.6.JNS132471. Epub 2014 Jul 4. PubMed PMID: 24995779.