gms | German Medical Science

Background: In most of the cases intra-labyrinthine schwannoma (ILS) occur in patients with unilateral hearing deterioration or neurofibromatosis typ II (NF II). The pattern of localization of these tumors is various but affects mostly the cochlea. Extirpation of the ILS, if hidden by the cochlea modiolus, is difficult under the aspect of complete removal. Therefore, a tissue removal device (TRD) was designed and tested in temporal bones. Principle of handling of the new device is a pushing and pipe cleaner handling inside the cochlea. The aim of this present study was to describe the first in vivo experience with the newly developed TRD for the removal of cochlear intra-labyrinthine schwannoma.

Methods: In three patients the TRD was used for the tumor removal of ILS. In one patient with a cochlear schwannoma in a combination with a cochlea implantation and in one patient with suffering from NF II a cochlear schwannoma was removed with the TRD. The access was performed about a posterior tympanotomy, enlarged round window approach and an additional second turn access. The device was inserted and extracted gradually from the second turn access until the rings were visible in the second turn access. By a pushing and pipe cleaner handling the tumors were removed. An MRI control was performed on the day postoperatively with a T1 GAD sequence.

Results: Tumor removal with the TRD was performed in a 15 min procedure. MRI control confirmed a complete removal on the postoperative day in both cases.

Conclusion: In vivo handling of the device confirmed a straight forward handling for tumor removal. MRI scanning showed a complete removal of the tumor by the TRD.