Instrumentation for Acoustic Neuroma Microneurosurgery

The most important instruments for vestibular schwannoma surgery can be grouped as follows: standard microsurgical instruments, electronic microsurgical devices, endoscopes, and intraoperative neurophysiological monitoring (IONM) devices. Standard—i.e., mechanical—microsurgical instruments are used for tumor dissection, fragmentation, and piecemeal resection. Electronic microsurgical devices consist of bipolar forceps, used to achieve precise hemostasis; handheld 2μ-thulium flexible laser fiber, which can be used for hemostasis, capsule and dural incision and vaporization, and tumor debulking; and ultrasonic aspirator, mainly used for tumor debulking and internal auditory canal (IAC) opening. The endoscopes allow direct observation of the lateral extremity of the IAC and enable the surgeon to visualize and remove the deepest tumor remnants. IONM devices stimulate both facial and cochlear nerves and detect their responses so as to offer real-time monitoring of their functional state during surgery.