Retrosigmoid endoscopic keyhole for vestibular schwannomas: Systematic review and meta-analysis
Keywords:
endoscopy, retrosigmoid craniotomy, vestibular schwannoma.Abstract
Introduction: The development of endoscopy for vestibular schwannomas in recent decades offers a panoramic view of the structures of this location that is superior to microscopic vision.
Objective: To specify role of the retrosigmoid endoscopic keyhole in vestibular schwannomas.
Method: The search was developed in Medline. The following terms in English with Boolean operators were used: "Vestibular schwannoma" OR "acoustic neurinoma" AND "keyhole approach" OR "endoscopic resection" OR "endoscopy". Spanish and English language restriction was used. Editorial articles, letters to the editor, books, single case presentations, reviews, meta-analyses, and those with poor method were excluded; also articles on anatomical specimens. The Major package of the Jamovi software was used to perform a single-arm meta-analysis of total resection and "acceptable" post-surgical facial function, and estimate the overall effect. I 2 greater than 75 % was taken as high heterogeneity.
Results: Eight articles were chosen for the study. In the analysis of total resection, it is estimated at 0.84 for a p-value less than 0.01. It was similar in the case of preservation of "acceptable" facial function, with 0.77. In a subgroup analysis, those series where the diameters of the tumor lesion were greater than 3 cm showed less preservation of facial function. The anatomical preservation of the facial nerve was less than 90 % in two series.
Conclusions: The retrosigmoid endoscopic keyhole is an effective and safe technique in vestibular schwannomas. Studies in this regard reveal relative success, with acceptable rates of anatomical and functional preservation of the facial nerve.
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References
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16. Piloto OL, Hernandez TMC, Liño GT, Barreto A, Flores CDV, Ayala OL, et al. Endoscopic Keyhole and Microsurgery Approach to Cerebellopontine angle Tumors: Surgical outcomes. Mathews Journal of Case Reports. 2020 [access: 09/08/2023];5(2):1-7. Available at: https://www.mathewsopenaccess.com/full-text/endoscopic-keyhole-and-microsurgery-approach-to-cerebellopontine-angle-tumors-surgical-outcomes
17. CohenNL. Retrosigmoid approach for acoustic tumor removal. Otolaryngol Clin North Am. 1992 [access: 09/08/2023];25(2):295-310. Available at: https://pubmed.ncbi.nlm.nih.gov/1630830/
18. Marchioni D, Carner M, Rubini A, Nogueira JF, Masotto B, Alicandri-Ciufelli M, et al. The Fully Endoscopic Acoustic Neuroma Surgery. Otolaryngol Clin North Am. 2016 [access: 09/08/2023];49(5):1227-36. Available at: https://pubmed.ncbi.nlm.nih.gov/27565388/
19. XiaYin, Lixi-ping, Hande-min, ZhengJun, Longhai-shan, Shijin-feng. Anatomical structural study of cerebellopontine angle via endoscope. Chinese Medical Journal. 2007. DOI: 10.5555/cmj.0366-6999.120.20.p1836.01
20. Corrivetti F, Cacciotti G, Scavo CG, Roperto R, Stati G, Sufianov A, et al. Flexible endoscopic assistance in the surgical management of vestibular schwannomas. Neurosurg Rev. 2021;44(1):363-71. DOI: 10.1007/s10143-019-01195-0
21. Dubernard X, Kleiber JC, Makeieff M, Bazin A, Chays A. Drilling and control of the internal auditory canal by fixed endoscope. European annals of otorhinolaryngology, head and neck diseases. 2019 [access: 09/08/2023];136(1):37-39. Available at: https://pubmed.ncbi.nlm.nih.gov/30318323/
22. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery. 1997 [access: 09/08/2023];40(2):248-60. Available at: https://pubmed.ncbi.nlm.nih.gov/9007856/
23. Horta-Tamayo EE, Ortega-Raez DR, Acosta-González LC, López-Piloto O, Martínez-Valdés L, Suárez-Cruz M. Tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares. Revista Cubana de Medicina Militar. 2023 [access: 19/12/2023];52(4):02302960. Available at: https://revmedmilitar.sld.cu/index.php/mil/article/view/2960
24. Marchioni D, Gazzini L, Boaria F, Pinna G, Masotto B, Rubini A. Is endoscopic inspection necessary to detect residual disease in acoustic neuroma surgery? Eur Arch Otorhinolaryngol. 2019 [access: 09/08/2023];276(8):2155-63. Available at: https://doi.org/10.1007/s00405-019-05442-4
25. Kumon Y, Kohno S, Ohue S, Watanabe H, Inoue A, Iwata S, et al. Usefulness of endoscope-assisted microsurgery for removal of vestibular schwannomas. J Neurol Surg B Skull Base. 2012 [access: 09/08/2023];73(1):42-7. Available at: https://pubmed.ncbi.nlm.nih.gov/23372994/
26. Jianqing C, Yongchuan C, Zhihua Z, Huan J, Zhaoyan W, Hao W. A microscope-assisted endoscopic transcanal transpromontorial approach for vestibular schwannoma resection: a preliminary report. Eur Arch Otorhinolaryngol. 2022; 279(1):75-82. DOI: 10.1007/s00405-021-06612-z
27. Chen CK, Hsieh LC, Lu YJ, Lin CP. An Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannomas using a Computer-Based Three-Dimensional Imaging System. Journal of Visualized Experiments. 2021 [access: 22/02/2024]; (173):e60069. Available at: https://www.jove.com/es/v/60069/an-endoscopic-transcanal-transpromontorial-approach-for-vestibular
28. Patel TR, Fleischer L, Wiet RM, Michaelides EM. Resection of Intracochlear Schwannomas With Immediate Cochlear Implantation. Ann Otol Rhinol Laryngol . 2023; 132(4):387-93. DOI: 10.1177/00034894221092844
29. Tengku Kamalden TMI, Misron K, Arumugam PA. Endoscopic intracanalicular vestibular schwannoma excision via middle ear approach: A surgical option. Acta Oto-Laryngologica. 2021; 141(7):678-83. DOI: 10.1080/00016489.2021.1916074
30. Corrivetti F, Cacciotti G, Scavo CG, Roperto R, Stati G, Sufianov A, et al. Flexible endoscopic assistance in the surgical management of vestibular schwannomas. Neurosurg Rev. 2021; 44(1):363-71. DOI: 10.1007/s10143-019-01195-0
31. De Marco R, Lo Bue E, Di Perna G, Penner F, Vercelli A, Baldassarre BM, et al. Introducing endoscopic assistance on routinary basis for vestibular schwannomas resection: A single centre acceptance analysis. Neurochirurgie. 2024; 70(1):101524. DOI: 10.1016/j.neuchi.2023.101524
32. Hosoya M, Nishiyama T, Wakabayashi T, Shimanuki MN, Miyazaki H, Ozawa H, et al. Vestibular Schwannoma Surgery with Endoscope-Assisted Retrolabyrinthine Approach under Modified Reinforced Continuous Intraoperative Monitoring for Hearing Preservation: Experience of 33 Cases in a Single Center. Diagnostics. 2023 [access: 22/02/2024]; 13(2):275. Available at: https://www.mdpi.com/2075-4418/13/2/275
33. Zhang H, Wang J, Liu J, Cao Z, Liu X, Jin H, et al. Fully neuroendoscopic resection of cerebellopontine angle tumors through a retrosigmoid approach: a retrospective single-center study. Neurosurg Rev. 2023; 47(1):14. DOI: 10.1007/s10143-023-02244-5
34. Wu J, Sun H, Chen B, Yuan Y, Wang W, Ren D. Full Endoscopic Resection of Intralabyrinthine Schwannomas: A Case Series. Ear Nose Throat J. 2023; 1455613231176170. DOI: 10.1177/01455613231176170
35. Yang S, Wang J, Yang C, Li Z, Qiao Y, Wang C, et al. An Investigation Into Whether the Facial Nerve and Auditory Nerve can be Protected by Removal of the Posterior Wall of the Internal Auditory Canal Under 30° Neuroendoscopy During Vestibular Schwannoma Surgery. Journal of Craniofacial Surgery. 2023 [access: 22/02/2024]; 10.1097/SCS.0000000000009826. Available at: https://journals.lww.com/jcraniofacialsurgery/abstract/9900/an_investigati-on_into_whether_the_facial_nerve_and.1148.aspx
2. Magnan J, Chays A, Lepetre C, Pencroffi E, Locatelli P. Surgical perspectives of endoscopy of the cerebellopontine angle. Am J Otol. 1994 [access: 09/08/2023];15(3):366-70. Available at: https://pubmed.ncbi.nlm.nih.gov/8579141/
3. Raza-Knight S, Chiuta S, Golash A, Gurusinghe N, Roberts G, Alalade AF. The Role of Endoscopy in the Resection of Sporadic Vestibular Schwannomas: A Systematic Review of Surgical Outcomes. Otology & Neurotology. 2022 [access: 09/08/2023];43(1):2-11. Available at: https://pubmed.ncbi.nlm.nih.gov/34510120/
4. Horta-Tamayo EE, Ortega-Raez DR, Acosta-González LC. Tratamiento multimodal en los schwanomas vestibulares grandes. Revista Cubana de Cirugía. 2023 [access: 19/12/2023];62(3):e1489. Available at: https://revcirugia.sld.cu/index.php/cir/article/view/1489
5. Muelleman TJ, Maxwell AK, Peng KA, Brackmann DE, Lekovic GP, Mehta GU. Anatomic Assessment of the Limits of an Endoscopically Assisted Retrolabyrinthine Approach to the Internal Auditory Canal. J Neurol Surg B Skull Base. 2021 [access: 09/08/2023];82(Suppl 3):e184-9. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289559/
6. Kabil MS, Shahinian HK. A Series of 112 Fully Endoscopic Resections of Vestibular Schwannomas. Minimally Invasive Neurosurgery. 2006 [access: 09/08/2023];49(6):362-8. Available at: http://www.thieme-connect.de/DOI/DOI?10.1055/s-2006-955068
7. Shahinian HK, Ra Y. 527 fully endoscopic resections of vestibular schwannomas. Minimally Invasive Neurosurg. 2011 [access: 09/08/2023];54(2):61-7. Available at: https://pubmed.ncbi.nlm.nih.gov/21656440/
8. Yang Z, Xiong X, Jian Z, Du L. Analysis of the effect of neuroendoscopy-assisted microscopy in the treatment of Large (Koos grade IV) vestibular schwannoma. Front Oncol. 2023 [access: 09/08/2023];13:1033954. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9887138/
9. Salameh JP, Bossuyt PM, McGrath TA, Thombs BD, Hyde CJ, Macaskill P, et al. Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. BMJ. 2020 [access: 09/08/2023];370:m2632. Available at: https://pubmed.ncbi.nlm.nih.gov/32816740/
10. Sims CR, Warner MA, Stelfox HT, Hyder JA. Above the GRADE: Evaluation of Guidelines in Critical Care Medicine. Crit Care Med. 2019 [access: 09/08/2023];47(1):109-13. Available at: https://pubmed.ncbi.nlm.nih.gov/30303840/
11. Gerganov VM, Romansky KV, Bussarsky VA, Noutchev LT, Iliev IN. Endoscope-assisted microsurgery of large vestibular schwannomas. Minimally Invasive Neurosurg. 2005 [access: 09/08/2023];48(1):39-43. Available at: https://pubmed.ncbi.nlm.nih.gov/15747215/
12. Setty P, D'Andrea KP, Stucken EZ, Babu S, LaRouere MJ, Pieper DR. Endoscopic Resection of Vestibular Schwannomas. J Neurol Surg B Skull Base. 2015 [access: 09/08/2023];76(3):230-8. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433394/
13. Hoshide R, Faulkner H, Teo M, Teo C. Keyhole retrosigmoid approach for large vestibular schwannomas: strategies to improve outcomes. Neurosurgical Focus. 2018 [access: 09/08/2023];44(3):E2. Available at: https://thejns.org/focus/view/journals/neurosurg-focus/44/3/article-pE2.xml
14. Parab A, Khatri D, Singh S, Gosal JS, Deora H, Das KK, et al. Endoscopic Keyhole Retromastoid Approach in Neurosurgical Practice: Ant-Man's View of the Neurosurgical Marvel. World Neurosurgery. 2019 [access: 09/08/2023];126:e982-8. Available at: https://www.sciencedirect.com/science/article/pii/S1878875019306436
15. Caballero-García J, Morales-Pérez I, Michel-Giol-Álvarez A, Aparicio-García C, López-Sánchez M, Huanca-Amaru J. Endoscopic retrosigmoid keyhole approach in cerebellopontine angle tumors. A surgical cohort. Neurosurgery (English Edition). 2021 [access: 09/08/2023];32(6):268-77. Available at: https://www.sciencedirect.com/science/article/pii/S2529849621000010
16. Piloto OL, Hernandez TMC, Liño GT, Barreto A, Flores CDV, Ayala OL, et al. Endoscopic Keyhole and Microsurgery Approach to Cerebellopontine angle Tumors: Surgical outcomes. Mathews Journal of Case Reports. 2020 [access: 09/08/2023];5(2):1-7. Available at: https://www.mathewsopenaccess.com/full-text/endoscopic-keyhole-and-microsurgery-approach-to-cerebellopontine-angle-tumors-surgical-outcomes
17. CohenNL. Retrosigmoid approach for acoustic tumor removal. Otolaryngol Clin North Am. 1992 [access: 09/08/2023];25(2):295-310. Available at: https://pubmed.ncbi.nlm.nih.gov/1630830/
18. Marchioni D, Carner M, Rubini A, Nogueira JF, Masotto B, Alicandri-Ciufelli M, et al. The Fully Endoscopic Acoustic Neuroma Surgery. Otolaryngol Clin North Am. 2016 [access: 09/08/2023];49(5):1227-36. Available at: https://pubmed.ncbi.nlm.nih.gov/27565388/
19. XiaYin, Lixi-ping, Hande-min, ZhengJun, Longhai-shan, Shijin-feng. Anatomical structural study of cerebellopontine angle via endoscope. Chinese Medical Journal. 2007. DOI: 10.5555/cmj.0366-6999.120.20.p1836.01
20. Corrivetti F, Cacciotti G, Scavo CG, Roperto R, Stati G, Sufianov A, et al. Flexible endoscopic assistance in the surgical management of vestibular schwannomas. Neurosurg Rev. 2021;44(1):363-71. DOI: 10.1007/s10143-019-01195-0
21. Dubernard X, Kleiber JC, Makeieff M, Bazin A, Chays A. Drilling and control of the internal auditory canal by fixed endoscope. European annals of otorhinolaryngology, head and neck diseases. 2019 [access: 09/08/2023];136(1):37-39. Available at: https://pubmed.ncbi.nlm.nih.gov/30318323/
22. Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery. 1997 [access: 09/08/2023];40(2):248-60. Available at: https://pubmed.ncbi.nlm.nih.gov/9007856/
23. Horta-Tamayo EE, Ortega-Raez DR, Acosta-González LC, López-Piloto O, Martínez-Valdés L, Suárez-Cruz M. Tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares. Revista Cubana de Medicina Militar. 2023 [access: 19/12/2023];52(4):02302960. Available at: https://revmedmilitar.sld.cu/index.php/mil/article/view/2960
24. Marchioni D, Gazzini L, Boaria F, Pinna G, Masotto B, Rubini A. Is endoscopic inspection necessary to detect residual disease in acoustic neuroma surgery? Eur Arch Otorhinolaryngol. 2019 [access: 09/08/2023];276(8):2155-63. Available at: https://doi.org/10.1007/s00405-019-05442-4
25. Kumon Y, Kohno S, Ohue S, Watanabe H, Inoue A, Iwata S, et al. Usefulness of endoscope-assisted microsurgery for removal of vestibular schwannomas. J Neurol Surg B Skull Base. 2012 [access: 09/08/2023];73(1):42-7. Available at: https://pubmed.ncbi.nlm.nih.gov/23372994/
26. Jianqing C, Yongchuan C, Zhihua Z, Huan J, Zhaoyan W, Hao W. A microscope-assisted endoscopic transcanal transpromontorial approach for vestibular schwannoma resection: a preliminary report. Eur Arch Otorhinolaryngol. 2022; 279(1):75-82. DOI: 10.1007/s00405-021-06612-z
27. Chen CK, Hsieh LC, Lu YJ, Lin CP. An Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannomas using a Computer-Based Three-Dimensional Imaging System. Journal of Visualized Experiments. 2021 [access: 22/02/2024]; (173):e60069. Available at: https://www.jove.com/es/v/60069/an-endoscopic-transcanal-transpromontorial-approach-for-vestibular
28. Patel TR, Fleischer L, Wiet RM, Michaelides EM. Resection of Intracochlear Schwannomas With Immediate Cochlear Implantation. Ann Otol Rhinol Laryngol . 2023; 132(4):387-93. DOI: 10.1177/00034894221092844
29. Tengku Kamalden TMI, Misron K, Arumugam PA. Endoscopic intracanalicular vestibular schwannoma excision via middle ear approach: A surgical option. Acta Oto-Laryngologica. 2021; 141(7):678-83. DOI: 10.1080/00016489.2021.1916074
30. Corrivetti F, Cacciotti G, Scavo CG, Roperto R, Stati G, Sufianov A, et al. Flexible endoscopic assistance in the surgical management of vestibular schwannomas. Neurosurg Rev. 2021; 44(1):363-71. DOI: 10.1007/s10143-019-01195-0
31. De Marco R, Lo Bue E, Di Perna G, Penner F, Vercelli A, Baldassarre BM, et al. Introducing endoscopic assistance on routinary basis for vestibular schwannomas resection: A single centre acceptance analysis. Neurochirurgie. 2024; 70(1):101524. DOI: 10.1016/j.neuchi.2023.101524
32. Hosoya M, Nishiyama T, Wakabayashi T, Shimanuki MN, Miyazaki H, Ozawa H, et al. Vestibular Schwannoma Surgery with Endoscope-Assisted Retrolabyrinthine Approach under Modified Reinforced Continuous Intraoperative Monitoring for Hearing Preservation: Experience of 33 Cases in a Single Center. Diagnostics. 2023 [access: 22/02/2024]; 13(2):275. Available at: https://www.mdpi.com/2075-4418/13/2/275
33. Zhang H, Wang J, Liu J, Cao Z, Liu X, Jin H, et al. Fully neuroendoscopic resection of cerebellopontine angle tumors through a retrosigmoid approach: a retrospective single-center study. Neurosurg Rev. 2023; 47(1):14. DOI: 10.1007/s10143-023-02244-5
34. Wu J, Sun H, Chen B, Yuan Y, Wang W, Ren D. Full Endoscopic Resection of Intralabyrinthine Schwannomas: A Case Series. Ear Nose Throat J. 2023; 1455613231176170. DOI: 10.1177/01455613231176170
35. Yang S, Wang J, Yang C, Li Z, Qiao Y, Wang C, et al. An Investigation Into Whether the Facial Nerve and Auditory Nerve can be Protected by Removal of the Posterior Wall of the Internal Auditory Canal Under 30° Neuroendoscopy During Vestibular Schwannoma Surgery. Journal of Craniofacial Surgery. 2023 [access: 22/02/2024]; 10.1097/SCS.0000000000009826. Available at: https://journals.lww.com/jcraniofacialsurgery/abstract/9900/an_investigati-on_into_whether_the_facial_nerve_and.1148.aspx
Published
2024-04-12
How to Cite
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Horta-Tamayo EE, Ortega-Raez DR, RodrÃguez Santillan LB, Acosta González LC, Suárez RodrÃguez M, González González A. Retrosigmoid endoscopic keyhole for vestibular schwannomas: Systematic review and meta-analysis. Rev Cubana Med Milit [Internet]. 2024 Apr. 12 [cited 2025 Jun. 12];53(2):e024020508. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/20508
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