유양동 삭개술 없이 내시경적 갑각하 접근법을 통한 청신경초종 제거와 인공와우 이식을 동시에 시행하여 청력을 회복한 증례

Abstract

Various approaches have been applied to surgery of vestibular schwannomas (VSs) and preservation of hearing, when possible, has been one of important goals of VS surgery. In recent years, several attempts have been made to restore damaged hearing with implants, going beyond simple preservation of hearing, in addition to tumor removal. We present a case of a 40-year-old male who had a 7-mm intracanalicular VS with profound ipsilateral hearing loss. The patient underwent nonmastoidectomy endoscopic transcanal infrapromontorial tumor removal with concurrent cochlear implantation on the ipsilateral side, without any complication during or after surgery. Postoperative pure-tone audiometry showed notable improvement to 21 dB HL. With this approach, the infrapromontorial corridor provided space to remove the tumor and most of the normal cochlear structure was preserved, allowing stable insertion of a cochlear implant electrode. This case suggests that nonmastoidectomy infrapromontorial approach and concurrent cochlear implantation can achieve both minimally invasive tumor removal and restoration of hearing simultaneously.