{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:54:38Z","timestamp":1760144078370,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Introduction: The middle cranial fossa (MCF) approach is a well-established procedure in surgery of the internal auditory canal, as well as with the retrosigmoid and translabyrinthine approaches. It is commonly used in the hearing-preserving microsurgery of small vestibular schwannomas (VS). The debate about the \u201cbest\u201d approach for the microsurgery of small VS without contact to the brainstem is controversial. It has been stated that the MCF approach leads to irreversible damage to the temporal lobe, which may be evident in follow-up magnet resonance imaging (MRI) as gliosis in up to 70% of patients. Materials and Methods: This study represents a retrospective chart analysis conducted at a tertiary university hospital. Here, 76 postoperative MRIs were re-evaluated by an experienced neuroradiologist and compared with the preoperative images. Temporal lobe gliosis was classified on an ordinal scale as absent, slight, moderate or severe. Occurrence of gliosis was matched to the clinical predictors (tumor stage, tumor volume, sex, age, and side). Results: No case of severe or moderate gliosis was found in the patient group. Slight gliosis of the temporal lobe was rare and was only detected in four patients (5%). There was no relation between clinical predictors and the incidence of gliosis. Conclusions: In our cohort, postoperative MR imaging did not reveal relevant damage to the temporal lobe parenchyma. This confirms the safe concept of microsurgery of small tumors via the middle fossa approach. The severe glioses described in other studies may be caused by a forced insertion of the retractor or by more extended approaches. However, further prospective neurocognitive studies seem to be necessary in order to assess functional changes in the temporal lobe.<\/jats:p>","DOI":"10.3390\/brainsci14030295","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T10:44:33Z","timestamp":1710931473000},"page":"295","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Retrospective Analysis of Temporal Lobe Gliosis after Middle Fossa Resection of Small Vestibular Schwannomas"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3694-6354","authenticated-orcid":false,"given":"Matthias","family":"Scheich","sequence":"first","affiliation":[{"name":"Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of W\u00fcrzburg, Josef-Schneider-Str. 11, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"B\u00fcrklein","sequence":"additional","affiliation":[{"name":"Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of W\u00fcrzburg, Josef-Schneider-Str. 11, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8069-4342","authenticated-orcid":false,"given":"Manuel","family":"St\u00f6th","sequence":"additional","affiliation":[{"name":"Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of W\u00fcrzburg, Josef-Schneider-Str. 11, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brigitte","family":"Bison","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rudolf","family":"Hagen","sequence":"additional","affiliation":[{"name":"Department of General Practice, University Hospital of W\u00fcrzburg, Josef-Schneider-Str. 2, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6995-1849","authenticated-orcid":false,"given":"Stephan","family":"Hackenberg","sequence":"additional","affiliation":[{"name":"Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of W\u00fcrzburg, Josef-Schneider-Str. 11, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius L.","family":"Vogt","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Hospital of W\u00fcrzburg, Josef-Schneider-Str. 11, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1097\/MAO.0b013e3181c0e98e","article-title":"The history of middle cranial fossa approach to the cerebellopontine angle","volume":"31","author":"Monfared","year":"2010","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1288\/00005537-196111000-00004","article-title":"Surgical exposure of the internal auditory canal and its contents through the middle, cranial fossa","volume":"71","author":"House","year":"1961","journal-title":"Laryngoscope"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/BF02594468","article-title":"Transtemporal extralabyrinthine surgery of the internal auditory canal","volume":"194","author":"Fisch","year":"1969","journal-title":"Arch. Klin. Exp. Ohren Nasen Kehlkopfheilkd."},{"key":"ref_4","first-page":"614","article-title":"Technical modifications to the middle fossa craniotomy approach in removal of acoustic neuromas","volume":"15","author":"Brackmann","year":"1994","journal-title":"Am. J. Otol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1055\/s-0040-1722718","article-title":"Auditory Brain Stem Response Predictors of Hearing Outcomes after Middle Fossa Resection of Vestibular Schwannomas","volume":"83","author":"Ren","year":"2022","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3171\/2022.10.JNS221525","article-title":"Factors associated with hearing outcomes after a middle fossa approach in 131 consecutive patients with vestibular schwannomas","volume":"139","author":"Budohoski","year":"2022","journal-title":"J. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1007\/s00405-012-2074-8","article-title":"Outcome on hearing and facial nerve function in microsurgical treatment of small vestibular schwannoma via the middle cranial fossa approach","volume":"270","author":"Ginzkey","year":"2013","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"186","DOI":"10.5152\/iao.2017.3585","article-title":"Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal","volume":"13","author":"Scheich","year":"2017","journal-title":"J. Int. Adv. Otol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"506","DOI":"10.3171\/jns.1998.88.3.0506","article-title":"Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas","volume":"88","author":"Koos","year":"1998","journal-title":"J. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"473","DOI":"10.3390\/audiolres13040042","article-title":"Prognostic Factors for Hearing Preservation Surgery in Small Vestibular Schwannoma","volume":"13","author":"Concheri","year":"2023","journal-title":"Audiol. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/mao.0b013e31815c2ad7","article-title":"Magnetic resonance imaging and neuropsychological testing after middle fossa vestibular schwannoma surgery","volume":"29","author":"Schick","year":"2008","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/00005537-200303000-00006","article-title":"Postoperative magnetic resonance imaging findings after transtemporal and translabyrinthine vestibular schwannoma resection","volume":"113","author":"Brors","year":"2003","journal-title":"Laryngoscope"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1055\/s-2005-870573","article-title":"Functional results, cognitive and effective quality of life disturbances after trans-temporal resection of acoustic neuroma","volume":"84","author":"Minovi","year":"2005","journal-title":"Laryngo-Rhino-Otol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.neuron.2013.12.034","article-title":"Reactive gliosis and the multicellular response to CNS damage and disease","volume":"81","author":"Burda","year":"2014","journal-title":"Neuron"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.bbadis.2015.11.014","article-title":"Reactive gliosis in the pathogenesis of CNS diseases","volume":"1862","author":"Pekny","year":"2016","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_16","first-page":"S11","article-title":"The middle cranial fossa approach","volume":"Volume 39","author":"Zanoletti","year":"2019","journal-title":"Surgery of the Lateral Skull Base: A 50-Year Endeavour"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.otc.2023.02.009","article-title":"Middle Cranial Fossa Approach for Sporadic Vestibular Schwannoma: Patient Selection, Technical Pearls, and Hearing Results","volume":"56","author":"Kashani","year":"2023","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1148\/rg.297095713","article-title":"Surgical approaches to vestibular schwannomas: What the radiologist needs to know","volume":"29","author":"Silk","year":"2009","journal-title":"Radiographics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.nic.2021.08.005","article-title":"Imaging of the Postoperative Skull Base and Cerebellopontine Angle","volume":"32","author":"Yang","year":"2022","journal-title":"Neuroimaging Clin. N. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E18","DOI":"10.3171\/2012.6.FOCUS12150","article-title":"Postoperative imaging of vestibular schwannomas","volume":"33","author":"Ginat","year":"2012","journal-title":"Neurosurg. Focus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.otohns.2008.01.012","article-title":"Postoperative imaging of vestibular schwannomas","volume":"138","author":"Bennett","year":"2008","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_22","first-page":"197","article-title":"Gadolinium-enhanced MR of the postoperative internal auditory canal following acoustic neuroma resection via the middle fossa approach","volume":"13","author":"Mueller","year":"1992","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1097\/00129492-200409000-00023","article-title":"Clinical and radiologic sequelae of the middle fossa approach to the internal auditory canal","volume":"25","author":"Stripf","year":"2004","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/00129492-200103000-00019","article-title":"Enlarged middle fossa vestibular schwannoma surgery: Experience with 735 cases","volume":"22","author":"Gjuric","year":"2001","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1055\/s-2008-1057004","article-title":"Extended middle cranial fossa approach for acoustic neuroma surgery","volume":"1","author":"Wigand","year":"1991","journal-title":"Skull Base Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"16655","DOI":"10.1038\/s41598-019-52836-9","article-title":"Mechanical Properties of Human Dura Mater in Tension\u2014An Analysis at an Age Range of 2 to 94 Years","volume":"9","author":"Zwirner","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"418","DOI":"10.2176\/nmc.st.2017-0058","article-title":"Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy","volume":"57","author":"Karibe","year":"2017","journal-title":"Neurol. Med. Chir."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/MAO.0000000000002546","article-title":"The Direct Costs of Microsurgical Resection of Vestibular Schwannomas","volume":"41","author":"Saliba","year":"2020","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e268","DOI":"10.1097\/MAO.0000000000002510","article-title":"Is Longer Surgery More Dangerous? Operative Duration Not Associated With Complications After Vestibular Schwannoma Resection","volume":"41","author":"Raghavan","year":"2020","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1227\/01.NEU.0000374853.97891.FB","article-title":"Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: Retrosigmoid vs middle fossa approach","volume":"67","author":"Sameshima","year":"2010","journal-title":"Neurosurgery"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1007\/s00405-011-1791-8","article-title":"Use of flexible CO2 laser fiber in microsurgery for vestibular schwannoma via the middle cranial fossa approach","volume":"269","author":"Scheich","year":"2012","journal-title":"Eur. Arch. Otorhinolaryngol."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/3\/295\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:16:45Z","timestamp":1760105805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/3\/295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["brainsci14030295"],"URL":"https:\/\/doi.org\/10.3390\/brainsci14030295","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2024,3,20]]}}}