Endoscopic Transcanal Transpromontorial Approach for Vestibular Schwannoma Resection: A Case Series.

Objective: To demonstrate successful surgical management of vestibular schwannomas via an exclusively endoscopic transcanal transpromontorial approach (EETTA).
Patients: Four patients with vestibular schwannomas.
Interventions: Surgical excision via EETTA.
Main Outcomes: Technique refinements, tumor access, complete tumor removal, and patient morbidity.
Results: Three tumors were Koos grade I and one tumor was Koos grade II. All ears had non-serviceable hearing prior to surgery. The EETTA enabled access to the internal auditory canal and porus acousticus as well as limited access to the cerebellopontine angle. Gross total tumor resection was achieved in all cases. There were no intraoperative or postoperative complications and the mean hospital duration was 2.8 days. After a mean follow-up of 5.0 months, all cases had a good facial nerve outcome.
Conclusions: The EETTA can be successfully used for the management of small vestibular schwannomas in ears without serviceable hearing. Additional studies are needed to fully elucidate the risk-benefit profile of this minimally invasive approach.