gms | German Medical Science

Objective: Endoscope-assisted microsurgery has become a standard tool in the neurosurgical treatment of intracranial tumors and vascular lesions. It allows minimally invasive “key-hole” approaches, thereby reducing cerebral tissue traction. These kinds of approaches are particularly suited for deep seated and small tumours of the anterior cranial fossa, the suprasellar and parasellar regions. The contribution of endoscopy to standard microsurgery is based on its ability to better identify anatomical structures under limited viewing angles and behind corners. This can be achieved with angled endoscopes in order to reduce tissue manipulation and traction. Increased experience with endoscopic techniques has allowed for more extensive application of combined microsurgical and endoscopical approaches. In particular under direct endoscopic vision, it is possible to perform many surgical manoeuvres, using specifically designed instruments passed in surgical corridors alongside the endoscope, which can be fixed on a holder. In this way it is possible to realize a transcranial bimanual endoscopic technique (that can be defined “endoneurosurgery”), which allows for dissection and manipulation of structures that are not directly visualized under the operating microscope. Endoscopy has thus become complementary to standard microneurosurgery, and both techniques can be used in different phases of the same procedure. The authors describe their experience with a combined endoscopic and microsurgical technique in 10 cases of cranial tumors: 3 craniopharyngiomas, one epidermoid tumor of the sylvian region and six meningiomas, two of the anterior fossa and four of the parasellar region. We demonstrate the technical aspects of endoneurosurgery, its advantages and limitations with the help of our video material.