Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11...

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7-11 November 2016 Hands-on Course in: Lateral Skull Base Surgery Piacenza, Italy

Transcript of Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11...

Page 1: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

7-11 November 2016

Hands-on Course in:

Lateral Skull Base SurgeryPiacenza, Italy

Page 2: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Age – 43 yearsSex – FemaleHistory• RT for nasopharyngeal carcinoma (1993)• Right-sided tympanoplasty EAC chole (2003)• Onset of right hemifacial spasm and

progressive right HL (anacusis)

Case n.01

Right PBC

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Page 3: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.01

Right PBC

Radiological investigation - CT

Page 4: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.01

Right PBC

Radiological investigation - CT

Page 5: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.01

Right PBC

Radiological investigation - MRI

Page 6: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.01

Right PBC

Radiological investigation - MRI

Page 7: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.01

Right PBC

• Surgery

- Right transotic removal and Fallopian canal decompression (07/11/2016)

Post-operative CT scan

Page 8: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Case n.02

Left TJP

Class C3

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Age – 50 years

Sex – Female

History

-Progressive left HL pulsatile tinnitus since 2008

-PTA + ICA stenting (February 2016)

Page 9: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.02

Left TJP

Radiological investigation - CT

Page 10: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.02

Left TJP

Radiological investigation - CT

Page 11: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.02

Left TJP

Radiological investigation - MRI

Page 12: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.02

Left TJP

Radiological investigation - MRI

Page 13: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.02

Left TJP Radiological investigation

Angiography & Embolization

Page 14: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.02

Left TJP

• Surgery

- Left infratemporal fossa approach type A (with anterior rerouting of the facial nerve, 07/11/2016)

Post-operative CT scan

Page 15: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Case n.03

Left VS in

NF2 Pt

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Age – 47 years

Sex – Female

History

-Bilateral progressive HL (left worse) since July 2016, with imbalance

-Slight left FN dysfunction (grade 2)

-No previous diagnosis of neurofibromatosis type 2

Page 16: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.03

Left VS in NF2 Pt

Radiological investigation - MRI

Page 17: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.03

Left VS in NF2 Pt

Radiological investigation - MRI

Page 18: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.03

Left VS in NF2 Pt

Post-operative CT scan

• Surgery

- Removal via left translabyrinthineapproach with transapical extension (08/11/2016). She was planned for ABI insertion, that was not possible since Luschka foramen was not accessible.

Page 19: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Case n.04

Intrameatal

VS

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Age – 45 years

Sex – Female

History

-Progressive left HL, aural fullness, tinnitus and intermittent vertigo since 2015

Page 20: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.04

Intrameatal VS

Radiological investigation - MRI

Page 21: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.04

Intrameatal VS

Post-operative CT scan

• Surgery

- Initially planned for left TLA with CI, only TLA removal (08/11/2016) since the patient refused CI.

- The patient had already refused wait&scan

Page 22: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Case n.05

Right

Intracochlear

tumour

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Age – 60 years

Sex – Male

History

-Progressive right-sided HL and tinnitus since 2010

-Radiological finding of right intracochlear lesion since 2013, followed up

-Anacusis since 6 months ago

Page 23: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.05

Right intracochlear tumour

Radiological investigation - MRI

Page 24: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.05

Right intracochlear tumour

Post-operative CT scan

• Surgery

- Removal via right transotic approach on patient’s request (09/11/2016)

Page 25: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Case n.06

XII cn tumor

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Age – 36 years

Sex – Male

History

-Two-year history of left hypoglossal nerve palsy

-Delayed diagnosis

Page 26: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.06

XII cn tumor

Radiological investigation - CT

Page 27: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.06

XII cn tumor

Radiological investigation - MRI

Page 28: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.06

XII cn tumor

Radiological investigation - MRI

Page 29: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.06

XII cn tumor Radiological investigation

Angio - MRI

Page 30: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.06

XII cn tumor

Post-operative CT scan

• Surgery

- Infralabyrinthine transcondylar trans-sigmoid removal with neck extension

Page 31: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Case n.07

Right PB tumor

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Age – 41 years

Sex – Male

History

-Progressive right-sided HL with tinnitus in the last 6 months

Page 32: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.07

Right PB tumor

Radiological investigation - CT

Page 33: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.07

Right PB tumor

Radiological investigation - MRI

Page 34: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.07

Right PB tumor

Radiological investigation - MRI

Page 35: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

Hands-on Course in:

Lateral Skull Base Surgery

7-11 November 2016

Case n.07

Right PB tumor

Post-operative CT scan

• Surgery

- Removal via right infratemporal fossa approach type B with zygomatic extension (10/11/2016)

Page 36: Hands-on Course in: Lateral Skull Base Surgery...Hands-on Course in: Lateral Skull Base Surgery 7-11 November 2016 Case n.03 Left VS in NF2 Pt Post-operative CT scan •Surgery - Removal

7-11 November 2016

Hands-on Course in:

Lateral Skull Base SurgeryPiacenza, Italy