A case of Dr. Juan Casado
En SurgSchool, we incorporate a new skull base surgery, both for otorhinolaryngologists and neurosurgeons. In this case performed at the Miguel Servet Hospital in Zaragoza, Spain, the Dr. Juan Casado, a neurosurgeon, performed an excision of a Hannover 3B vestibular Schwannoma. The patient, aged 43, had severe hearing loss, but the tumor had not significantly displaced the brain stem or the fourth ventricle, which allowed for an effective surgical approach.
Surgical Approach
Positioning and Preparation
The surgery was performed with a retrosigmoid approach in the right lateral decubitus position. A caudal incision was made in the dura mater to release the cerebrospinal fluid, which facilitated relaxation of the cerebellum and allowed for better opening of the meningeal cavity.
Release of Neurovascular Structures
The next step was to release the lower cranial nerves from the arachnoid to prevent traction. This allowed the cerebellum to descend and facilitate access to the caudal portion of the Schwannoma as well as the adjacent neurovascular structures.
Tumor Resection Techniques
Dissection and Milling
El Dr. Casado The dissection of the most cranial part of the Schwannoma was started, and diamond burs were subsequently used to drill the internal auditory canal. The prior evaluation of the scan helped to determine the amount of bone to be resected.
Debulking and Monitoring
Debulking techniques with ultrasonic and bipolar suction were used to remove the tumor in stages. Continuous neurophysiological monitoring was crucial to ensure preservation of the facial nerve during resection.
Postoperative Results
Facial Nerve Preservation
During surgery, a ball-type electrode was placed for electromyographic monitoring of the facial nerve, allowing for safe resection of the Schwannoma. The patient was discharged in four days with minimal facial paralysis, improving to a House Brackmann-1 at discharge.
