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The first 25 slides, exactly as they appear. The full deck has 48 content slides.
Neurosurgery
Surgical Approaches to Vestibular Schwannomas
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
5 sections · 48 slides
Understanding the Tumor
What a vestibular schwannoma is and why it matters
- What is a vestibular schwannoma?
- The tumor by the numbers
- Genetics: why some patients grow several
- How patients present
- Three routes to the same target
- Not just schwannomas
- Choosing the approach
The Translabyrinthine Approach
The most direct route when hearing is already lost
- Who is it for?
- Weighing the translabyrinthine route
- Preoperative work-up: the history and exam
- Preoperative testing
- Setting up and positioning
- Incision and soft-tissue exposure
- Bone work: the extended mastoidectomy
- The labyrinthectomy
- Reaching the porus and the IAC
- Opening the dura and removing the tumor
- Controlling bleeding during bone work
- Closure of the translabyrinthine defect
- Why TL has the lowest CSF-leak rate
- After surgery: CSF and the facial nerve
The Retrosigmoid Approach
Transmeatal route: saving hearing in larger tumors
- Who is it for?
- Preoperative preparation
- Positioning and monitoring
- Equipment differences from the TL route
- Craniotomy and opening
- Relaxing the brain and debulking large tumors
- Small tumors: drill the canal first
- Drilling the internal auditory canal
- Removing the tumor and finding the plane
- Closure and postoperative course
The Middle Cranial Fossa Approach
From above the ear, for small tumors with good hearing
- Who is it for?
- Preoperative preparation
- Positioning and navigation
- Incision, flap, and dural elevation
- Drilling and tumor removal
- Bleeding and the vein of Labbe
- Postoperative management
Choosing Wisely
Matching the approach to the patient
- Three approaches side by side
- Take-home messages
- Why is the internal auditory canal drilled BEFORE tumor dissection in a hearing-preservation retrosigmoid case?
- Neurosurgical Operative Atlas: Neuro-Oncology