10.14639/0392-100X-N1587
text/xml
1827-675X
1587
en
Antonio Mazzoni
https://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
Response to: “Transmeatal microsurgery for intralabyrinthine and intrameatal schwannomas: literature review”
Text.Serial.Journal
https://www.actaitalica.it/
41
Letters to the Editor-in-Chief
2021-07-07
2021-03-26
2021-07-08
2021-07-08
285-286
1
Antonio Mazzoni
2021/07/07
10.14639/0392-100X-N1587
285
Section of Otolaryngology, Department of Neurosciences DNS, Padua University, Padua, Italy
1827-675X
286
Response to: “Transmeatal microsurgery for intralabyrinthine and intrameatal schwannomas: literature review”
https://www.actaitalica.it/article/download/1587/629
41
ACTA OTORHINOLARYNGOLOGICA ITALICA 2021;41:285-286; doi: 10.14639/0392-100X-N1587




Letter to the Editor


Response to: “Transmeatal microsurgery
for intralabyrinthine and intrameatal schwannomas:
literature review”
Lettera in risposta a: “Approccio transmeatale microchirurgico nei neurinomi
intralabirintici e intrameatali: revisione della letteratura”
Elisabetta Zanoletti1, Diego Cazzador1,2, Leonardo Calvanese1, Domenico d’Avella3, Alessandro Martini1,
Antonio Mazzoni1
1
  Section of Otolaryngology, Department of Neurosciences DNS, Padova University, Padova, Italy; 2 Section of Human Anatomy,
Department of Neuroscience DNS, Padova University, Padova, Italy; 3 Academic Neurosurgery, Department of Neuroscience DNS,
Padova University, Padova, Italy
KEY WORDS: microsurgery, vestibular schwannoma, transmeatal approach, internal auditory canal
PAROLE CHIAVE: microchirurgia, schwannoma vestibolare, approccio transmeatale, condotto uditivo interno


Dear Editor,
We appreciated the comments by Marchioni and colleagues on our recent pa-
per: Transmeatal microsurgery for intralabyrinthine and intrameatal schwan-
nomas: a reappraisal 1. Productive debates generally lead towards improve-
ment, giving the opportunity to clarify key aspects.                                    Received: March 26, 2021
We pointed out, not because we “apparently ignore”, that the transmeatal mi-            Accepted: April 19, 2021

croscopic approach (TMMa) to the internal auditory canal (IAC) dated to the             Correspondence
seventies. It was a remarkable achievement as, to the best of our knowledge, it         Elisabetta Zanoletti
was the first mentioned microscopic route from the external auditory canal to           Otorhinolaryngology Unit, University of Padova
the IAC 2 and supported by extensive case material. No comments on indica-              via Giustiniani 2, 35128 Padova, Italy
                                                                                        Tel. +39 049 821 8778. Fax +39 049 821 1994
tions, drawbacks or limits of this surgical corridor were intentionally added           E-mail: elisabetta.zanoletti@unipd.it
to our paper, since they would have sounded anachronistic. Similarly, we did
recognize the contribution3,4 that the Modena-Bologna and Verona groups have            Funding
                                                                                        None.
made to the approach to the IAC for vestibular schwannomas removal. The
focus of our study was neither on the “Endoscopic Transcanal Transprom-                 Conflict of interest
ontorial approach”, nor on the “Expanded Transcanal Transpromontorial ap-               The Authors declare no conflict of interest.
proach”, directed to larger tumours in the cerebellopontine angle (CPA). Our
contribution aimed to report on the surgical route to the IAC with the micro-             How to cite this article: Zanoletti E, Cazzador
scope through the external auditory canal for intralabyrinthine and/or intra-             D, Calvanese L, et al. Response to: “Transmeatal
                                                                                          microsurgery for intralabyrinthine and in-
canalicular tumours, the same target of the transcanal endoscopic approach 3,             trameatal schwannomas: literature review”. Acta
but with little differences. When compared to the latter, TMMa does not re-               Otorhinolaryngol Ital 2021;41:285-286. https://
quire removal of the external auditory canal to make space for instruments, the           doi.org/10.14639/0392-100X-N1587
tympanic membrane is preserved in its anatomic position and the ear contour
                                                                                        © Società Italiana di Otorinolaringoiatria
of the external ear is completely maintained, thus avoiding the aesthetic mor-          e Chirurgia Cervico-Facciale
bidity inherent to the canal sacrifice and suture. The two-hands microsurgical
technique allowed safe handling of structures, while the endoscope improved                            OPEN ACCESS
magnification of surgical details and provided good iconographic material.              This is an open access article distributed in accordance with
                                                                                        the CC-BY-NC-ND (Creative Commons Attribution-Non-
The further expanded extension of the transcanal transpromontorial approach 4,          Commercial-NoDerivatives 4.0 International) license. The
was intentionally – and not “surprisingly” – not included in our study, because         article can be used by giving appropriate credit and mentio-
                                                                                        ning the license, but only for non-commercial purposes and
it was beyond the scope of our paper. Such extensive transcanal drilling of the         only in the original version. For further information: https://
tympanic bone, including the exposure of the internal carotid artery and the            creativecommons.org/licenses/by-nc-nd/4.0/deed.en




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E. Zanoletti et al.




jugular bulb, corresponds in the end to a pre-facial lateral    valuable contributions. A different surgical perspective on
petrosectomy (adding retroauricular incision, fat oblitera-     some already published scientific reports is not intended to
tion and cul-de-sac closure of the external auditory canal).    disclaim the preceding experiences but, on the contrary, to
Nevertheless, since it was mentioned in the letter, we take     offer a different point of view, where agreement or disa-
hereby the opportunity to raise some issues. The Koos III       greement may – of course – always follow.
tumour as shown in that paper4 does not correspond to a 3
cm tumor as stated by the authors, but to a 1.2 -1.3 cm tu-
mour. On the other hand, a plain translabyrinthine approach
                                                                References
to such “Koos III” CPA tumours is, in our opinion, still
                                                                1
                                                                    Mazzoni A, Zanoletti E, Cazzador D, et al. Transmeatal microsur-
                                                                    gery for intralabyrinthine and intrameatal schwannomas: a reap-
preferable over the expanded transcanal transpromontorial           praisal. Acta Otorhinolaryngol Ital 2020;40:390-395. https://doi.
approach. No further extensive drilling is required to ex-          org/10.14639/0392-100X-N0779
pose the internal carotid artery and jugular bulb in the tem-   2
                                                                    Alvarez De Cozar F, Antoli-Candela F. Chirurgie transvestibulaire.
poral bone, the external auditory canal is preserved and not        Rev Laryngol Otol Rhinol 1970;91:927-935.
closed, the neurovascular structures in the CPA are safely      3
                                                                    Marchioni D, Alicandri-Ciufelli M, Rubini A, et al. Endoscopic trans-
handled, and the cochlea is maintained in view of a pos-            canal corridors to the lateral skull base: Initial experiences. Laryngo-
                                                                    scope 2015;125(Suppl 5):S1-13. https://doi.org/10.1002/lary.25203
sible cochlear implant.                                         4
                                                                    Marchioni D, Soloperto D, Masotto D, et al. Transcanal transprom-
We hope to have answered to the issues raised by Mar-               ontorial acoustic neuroma surgery. Results and facial nerve out-
chioni et al., and we are pleased that a discussion has been        comes. Otol Neurotol 2018;39:242-249. https://doi.org/10.1097/
started on a topic that benefited from their original and           MAO.0000000000001658




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