Understanding the Translabyrinthine Approach for Neurosurgery Residents: Operative and Educational Video

TL;DR

This video demonstrates a surgical approach for removing large vestibular schwannomas, focusing on technique and educational insights for neurosurgery residents.

Contribution

The paper provides an educational video showcasing the translabyrinthine approach for vestibular schwannoma resection with intraoperative monitoring and decision-making.

Findings

A 3.2-cm vestibular schwannoma was successfully resected with near-total removal and functional preservation.

The translabyrinthine approach minimized brainstem retraction and was effective for large tumors in patients with nonserviceable hearing.

Postoperative facial palsy improved within 5 weeks, and no tumor recurrence was observed on follow-up imaging.

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.