Introduc¸ão: O cisto aracnóide no conduto auditivo interno é uma doenc¸a bastante rara, mas devido à sua ac¸ão compressiva sobre os nervos deste local, ele deve ser removido cirurgicamente. Várias técnicas cirúrgicas foram propostas, mas ninguém utilizou a abordagem retrosigmóide minimamente invasiva assistida por endoscopia para a sua remoc¸ão. Objetivo: Investigar a viabilidade do uso da abordagem retrosigmóide minimamente invasiva assistida por endoscopia para remoc¸ão cirúrgica de cistos aracnoides no conduto auditivo interno. Método: A abordagem retrosigmóide minimamente invasiva assistida por endoscopia permite o acesso ao conduto auditivo interno através de uma abordagem retrosigmóide minimamente invasiva que combina o uso de um microscópio e um endoscópio. É realizada em seis etapas: etapa do tecido mole, etapa óssea, etapa dura-máter, etapa do ângulo pontocerebelar (realizado com um endoscópio e um microscópio), remoc¸ão e fechamento assistidos por endoscópio-microscópico. Testamos a abordagem retrosigmóide minimamente invasiva assistida por endoscopia para remoc¸ão de cistos aracnoides no conduto auditivo interno em duas cabec¸as de cadáveres humanos (espécimes) de indivíduos afetados por distúrbios auditivosvestibulares e com cistos aracnoides no conduto auditivo interno confirmado por imagem de ressonância magnética. Resultados: A massa foi removida completamente e com sucesso nos dois espécimes sem lesão nos nervos e/ou vasos na área cirúrgica. Conclusão: Os resultados do nosso estudo são encorajadores e apoiam a viabilidade do uso da abordagem retrosigmóide minimamente invasiva assistida por endoscopia para remoc¸ão de cistos aracnoides no conduto auditivo interno. Embora mais estudos clínicos in vivo sejam necessários para confirmar a precisão e a seguranc¸a do uso da abordagem retrosigmóide minimamente invasiva assistida por endoscopia para essa cirurgia específica, nosso grupo utilizou com sucesso a abordagem retrosigmóide minimamente invasiva assistida por endoscopia no tratamento da síndrome compressiva microvascular, remoc¸ão de schwannoma e ressecc¸ão do nervo vestibular.
Introduction: An arachnoid cyst in the internal auditory canal is a quite rare pathology but due to its compressive action on the nerves in this district should be surgically removed. Several surgical techniques have been proposed but no surgeons have used the minimally assisted endoscope retrosigmoid approach for its removal. Objective: To investigate the feasibility of using a minimally invasive endoscope assisted retro-sigmoid approach for surgical removal of arachnoid cysts in the internal auditory canal. Methods: Minimally invasive endoscope assisted retrosigmoid approach allows to access to the internal auditory canal through a minimally invasive retrosigmoid approach that combines the use of a microscope and an endoscope. It is performed in six steps: soft tissue step, bone step, dura step, cerebellopontine angle step (performed using an endoscope and a microscope), microscope-endoscope assisted arachnoid cysts removal and closure. We tested minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal on two human cadaveric heads (specimens) of subjects affected from audio-vestibular disorders and with arachnoid cysts in the internal auditory canal confirmed by magnetic resonance imaging. Results: The mass was completely and successfully removed from the two specimens with no damage to the nerves and/or vessels in the surgical area. Conclusion: The results of our study are encouraging and support the feasibility of using minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal. While further clinical in-vivo studies are needed to confirm the accuracy and safety of using the minimally invasive endoscope assisted retrosigmoid approach for this specific surgery, our group has successfully used the minimally invasive endoscope assisted retrosigmoid approach in the treatment of microvascular compressive syndrome, schwannoma removal and vestibular nerve resection.
A minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal: a step by step description / Di Stadio, A.; della Volpe, A.; Ralli, M.; Gambacorta, V.; Trabalzini, F.; Dipietro, L.; Ricci, G.. - In: BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY. - ISSN 1808-8694. - (2019). [10.1016/j.bjorl.2019.06.016]
A minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal: a step by step description
Di Stadio A.
Primo
;Ralli M.;
2019
Abstract
Introduction: An arachnoid cyst in the internal auditory canal is a quite rare pathology but due to its compressive action on the nerves in this district should be surgically removed. Several surgical techniques have been proposed but no surgeons have used the minimally assisted endoscope retrosigmoid approach for its removal. Objective: To investigate the feasibility of using a minimally invasive endoscope assisted retro-sigmoid approach for surgical removal of arachnoid cysts in the internal auditory canal. Methods: Minimally invasive endoscope assisted retrosigmoid approach allows to access to the internal auditory canal through a minimally invasive retrosigmoid approach that combines the use of a microscope and an endoscope. It is performed in six steps: soft tissue step, bone step, dura step, cerebellopontine angle step (performed using an endoscope and a microscope), microscope-endoscope assisted arachnoid cysts removal and closure. We tested minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal on two human cadaveric heads (specimens) of subjects affected from audio-vestibular disorders and with arachnoid cysts in the internal auditory canal confirmed by magnetic resonance imaging. Results: The mass was completely and successfully removed from the two specimens with no damage to the nerves and/or vessels in the surgical area. Conclusion: The results of our study are encouraging and support the feasibility of using minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal. While further clinical in-vivo studies are needed to confirm the accuracy and safety of using the minimally invasive endoscope assisted retrosigmoid approach for this specific surgery, our group has successfully used the minimally invasive endoscope assisted retrosigmoid approach in the treatment of microvascular compressive syndrome, schwannoma removal and vestibular nerve resection.File | Dimensione | Formato | |
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Di Stadio_A Minimally Invasive_2019.pdf
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