{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:38:17Z","timestamp":1762522697023,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T00:00:00Z","timestamp":1650499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Korean Research Foundation","award":["2018R1D1A1A02085472"],"award-info":[{"award-number":["2018R1D1A1A02085472"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The classical middle cranial fossa approach (MCFA) for vestibular schwannoma (VS) removal often requires a large incision and craniotomy, excessive temporal lobe manipulation, and a longer recovery. We describe a keyhole MCFA (KMCFA) with endoscopic assistance that allows for adequate access with minimal temporal lobe manipulation, resulting in a fast recovery and an invisible scar. Eight sides of four cadaveric heads were dissected through the endoscopic-assisted KMCFA to access the internal auditory canal (IAC). Furthermore, five patients with intracanalicular VS underwent tumor removal with the endoscopic-assisted KMCFA. During the endoscopic-assisted KMCFA with fine instruments, a 3-cm supra-auricular incision and a 2-cm diameter keyhole craniotomy achieved exposure of the entire length of the IAC in all cadaveric dissections without unintended violation of the cochlea, semicircular canal, and facial nerve. The gross tumor was totally removed in five patients with no major postoperative complications. The surgical time was reduced, the hearing outcomes were similar to those of the classical MCFA, and the scar was invisible 1 month after the surgery. The endoscopic-assisted KMCFA permits intracanalicular VS removal in a safe, efficient, and cosmetic way. For small intracanalicular VSs, this approach can replace the classical MCFA when indicated.<\/jats:p>","DOI":"10.3390\/jcm11092324","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T05:07:22Z","timestamp":1650604042000},"page":"2324","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Endoscopic-Assisted Keyhole Middle Cranial Fossa Approach for Small Vestibular Schwannomas"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3951-5074","authenticated-orcid":false,"given":"In Seok","family":"Moon","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ick Soo","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang 10380, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9352-8426","authenticated-orcid":false,"given":"Seung Ho","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4468-3646","authenticated-orcid":false,"given":"Seungjoon","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7893-1866","authenticated-orcid":false,"given":"Youngrak","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8111-2124","authenticated-orcid":false,"given":"Gina","family":"Na","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul 03722, Korea"},{"name":"Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang 10380, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,21]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1002\/lary.27208","article-title":"Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone","volume":"128","author":"Kutz","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/01.mao.0000185153.54457.16","article-title":"Hearing preservation and facial nerve outcomes in vestibular schwannoma surgery: Results using the middle cranial fossa approach","volume":"27","author":"Arts","year":"2006","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/MAO.0000000000000513","article-title":"Facial nerve outcomes after middle fossa decompression for bell\u2019s palsy","volume":"36","author":"Cannon","year":"2015","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1159\/000329362","article-title":"Analysis of hearing preservation and facial nerve function for patients undergoing vestibular schwannoma surgery: The middle cranial fossa approach versus the retrosigmoid approach--personal experience and literature review","volume":"17","author":"Russo","year":"2012","journal-title":"Audiol. Neuro-Otol."},{"key":"ref_6","first-page":"103","article-title":"Outcomes of middle fossa craniotomy for the repair of superior semicircular canal dehiscence","volume":"43","author":"Ung","year":"2017","journal-title":"J. Clin. Neurosci. Off. J. Neurosurg. Soc. Australas."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1055\/s-2008-1058629","article-title":"Transtemporal supralabyrinthine (middle cranial fossa) vestibular neurectomy: A review of the last 100 cases","volume":"6","author":"Fisch","year":"1996","journal-title":"Skull Base Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1177\/019459988008800430","article-title":"Middle fossa vestibular neurectomy: A report of 373 cases","volume":"88","year":"1980","journal-title":"Otolaryngol. -Head Neck Surg. Off. J. Am. Acad. Otolaryngol. -Head Neck Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sanna, M., and Hamada, M. (2011). Atlas of Acoustic Neurinoma Microsurgery, Thieme.","DOI":"10.1055\/b-002-66280"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1227\/NEU.0b013e31823110f1","article-title":"Hearing preservation using the middle fossa approach for the treatment of vestibular schwannoma","volume":"70","author":"Kutz","year":"2012","journal-title":"Neurosurgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.wneu.2017.08.153","article-title":"Endoscopic middle cranial fossa reconstruction with a subtemporal keyhole","volume":"108","author":"Komatsu","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.otot.2017.01.009","article-title":"Minimally invasive middle fossa craniotomy approach with endoscopic repair of superior canal dehiscence","volume":"28","author":"Kozin","year":"2017","journal-title":"Oper. Tech. Otolaryngol. -Head Neck Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/ons\/opw046","article-title":"Minimally invasive middle fossa keyhole craniectomy for repair of superior semicircular canal dehiscence","volume":"13","author":"Trieu","year":"2017","journal-title":"Oper. Neurosurg. (Hagerstown)"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e683","DOI":"10.1016\/j.wneu.2019.09.114","article-title":"Minimally invasive repair of tegmen defects through keyhole middle fossa approach to reduce hospitalization","volume":"133","author":"Wong","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1097\/MAO.0000000000000995","article-title":"Cadaveric study of an endoscopic keyhole middle fossa craniotomy approach to the superior semicircular canal","volume":"37","author":"Liming","year":"2016","journal-title":"Otol. Neurotol. Off. Publ. Am. Otol. Soc. Am. Neurotol. Soc. Eur. Acad. Otol. Neurotol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/13645700701705328","article-title":"Middle cranial fossa endoscopy using a rigid endoscope","volume":"16","author":"Mourgela","year":"2007","journal-title":"Minim Invasive Ther. Allied. Technol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/019459989310800202","article-title":"An external reference to identify the internal auditory canal in middle fossa surgery","volume":"108","author":"Catalano","year":"1993","journal-title":"Otolaryngol. -Head Neck Surg. Off. J. Am. Acad. Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1177\/000348940311200609","article-title":"Microsurgical anatomy of the perigeniculate ganglion area as seen from the middle cranial fossa approach","volume":"112","author":"Lee","year":"2003","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_19","first-page":"265","article-title":"A study on standardization of korean pb word list for speech audiometry","volume":"24","author":"Han","year":"1981","journal-title":"Korean J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1177\/0194599812458401","article-title":"A new standardized format for reporting hearing outcome in clinical trials","volume":"147","author":"Gurgel","year":"2012","journal-title":"Otolaryngol. -Head Neck Surg. Off. J. Am. Acad. Otolaryngol. -Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1097\/00005537-199708000-00021","article-title":"Hearing preservation after acoustic neuroma resection with tumor size used as a clinical prognosticator","volume":"107","author":"Hecht","year":"1997","journal-title":"Laryngoscope"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1288\/00005537-199210000-00010","article-title":"Preservation of hearing and facial nerve function in resection of acoustic neuroma","volume":"102","author":"Nadol","year":"1992","journal-title":"Laryngoscope"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0196-0709(00)80051-4","article-title":"Hearing preservation in acoustic neuroma surgery: Middle fossa versus retrosigmoid approach","volume":"21","author":"Staecker","year":"2000","journal-title":"Am. J. Otol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1227\/01.NEU.0000335783.70079.85","article-title":"Hearing preservation after intracanalicular vestibular schwannoma radiosurgery","volume":"63","author":"Niranjan","year":"2008","journal-title":"Neurosurgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3171\/2010.8.GKS101089","article-title":"Gamma knife surgery in vestibular schwannomas: Impact on the anterior and posterior labyrinth","volume":"113","author":"Gerosa","year":"2010","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/j.ijrobp.2005.10.024","article-title":"Long-term outcome of stereotactic radiosurgery (srs) in patients with acoustic neuromas","volume":"64","author":"Combs","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.ijrobp.2007.01.001","article-title":"Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 gy","volume":"68","author":"Chopra","year":"2007","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e374","DOI":"10.1097\/MAO.0000000000003457","article-title":"Comparing hearing outcomes in irradiated and conservatively managed vestibular schwannoma","volume":"43","author":"Ismail","year":"2022","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":"S287","DOI":"10.1055\/s-0039-1677859","article-title":"Middle fossa approach for resection of an intracanalicular vestibular schwannoma","volume":"80","author":"Jean","year":"2019","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_30","first-page":"295","article-title":"Expectant management of vestibular schwannoma: A retrospective multivariate analysis of tumor growth and outcome","volume":"21","author":"Hughes","year":"2011","journal-title":"Skull Base Off. J. N. Am. Skull Base Soc."},{"key":"ref_31","first-page":"255","article-title":"Conservative management of vestibular schwannomas: Third review of a 10-year prospective study","volume":"33","author":"Hajioff","year":"2008","journal-title":"Clin. Otolaryngol. Off. J. ENT-UK Off. J. Neth. Soc. Oto-Rhino-Laryngol. Cervico-Facial Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.3171\/JNS\/2008\/108\/6\/1220","article-title":"Comparison of the surgical and follow-up costs associated with microsurgical resection and stereotactic radiosurgery for vestibular schwannoma","volume":"108","author":"Banerjee","year":"2008","journal-title":"J. Neurosurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1097\/00005537-200408000-00026","article-title":"Retrosigmoid versus middle fossa surgery for small vestibular schwannomas","volume":"114","author":"Mangham","year":"2004","journal-title":"Laryngoscope"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1097\/MOO.0b013e32834a3fa7","article-title":"Current strategies in management of intracanalicular vestibular schwannoma","volume":"19","author":"Quesnel","year":"2011","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2324\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:58:21Z","timestamp":1760137101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,21]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["jcm11092324"],"URL":"https:\/\/doi.org\/10.3390\/jcm11092324","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,4,21]]}}}