Transcanal Transpromontorial Acoustic Neuroma Surgery: Results and Facial Nerve Outcomes

Background: Recently, the transcanal approach for the removal of acoustic neuromas has been introduced. Facial nerve (FN) preservation is one of the main challenges of this kind of surgery. Objective: To describe our experience in the surgical treatment of acoustic neuromas, focusing on the functional results of FN preservation after a transcanal approach. Methods: A retrospective chart review was carried out on clinical data and videos from operations on 49 patients who underwent surgery with a totally transcanal exclusive endoscopic approach for Koos stage I–II lesions, or an enlarged transcanal transpromontorial approach for Koos stage II–III tumors, between March 2012 and February 2017. Patients and tumor characteristics, clinical manifestations, radiologic features, audiological results, FN outcomes (according to the House–Brackmann [HB] grading system) and complications were evaluated. Tumors were classified according to the Koos grading system. Results: The age of the patients (34 females and 15 males) ranged from 27 to 77 years (mean age: 54.9 yr). Preoperative diagnosis was "vestibular schwannoma" in all patients. At the last follow-up (range 1–60 mo, mean 13.9 mo), 42 of 49 showed grade I HB FN function, 5 of 49 grade II HB, and 2 of 49 grade III HB. Overall, in 95.9%, FN function was preserved (grade I–II HB) with stable results at follow-up; in 4.1% of cases, FN function was reduced, but not worse than grade III. Conclusion: The transcanal approach represents a feasible, minimally invasive, and conservative technique for the management of acoustic neuromas of the internal auditory canal. Address correspondence and reprint requests to Cristoforo Fabbris, M.D., Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy; E-mail: cristoforo.fabbris@student.unife.it Author contributions: Conception and design: D.M., L.P. Acquisition of data: D.M., C.F., S.D.R., B.M., D.V. Analysis and interpretation of data: D.S., D.M. Drafting the article: D.S., D.M., C.F. Critically revising the article: D.M. Reviewed submitted version of manuscript: C.F. Approved the final version of the manuscript on behalf of all authors: C.F. Administrative/technical/material support: C.F., S.D.R., D.S., D.M. Study supervision: D.M. The authors disclose no conflicts of interest. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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