Artikel
Endoscope-assisted microsurgical removal of skull base tumors
Endoskopisch-assistierte mikrochirurgische Schädelbasischirurgie
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Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: In general, microsurgical removal is the therapy of choice for the treatment of benign skullbase tumors. The beneficial effect of endoscopes for the removal of such tumors is illustrated.
Methods: Seventy-one patients with a skull base tumor were treated using an endoscope-assisted microsurgical technique. The tumors included 32 meningeomas, 18 vestibular schwannomas, 6 epidermoids, 8 craniopharygeomas, and 7 miscellaneous lesions. Most of the tumor mass was removed using the operating microscope In 36 patients, tumor parts which were not visible in a straight line were removed under endoscopic control. In the remaining patients, the endoscope was used during the surgery for inspection only.
Results: All tumors except for four petroclival meningeomas with infiltration of the cavernous sinus (3) or brainstem (1) were completely removed. There was no mortality. Permanent neurological deficits included 4 facial palsies, 6 cases of deafness, 1 anosmia, and 1 hypoglossal palsy. In 14 patients, tumor parts were identified which were not visible under the microscope. Postoperative MR imaging revealed complete tumor resection in 67 cases (mean follow-up 14 months).
Conclusions: The endoscope-assisted microsurgical technique enables a safe tumor removal even when tumor parts are not visible in a straight line. Neurovascular retraction and skull base drilling can be reduced. Tumor extension into adjacent compartments, e. g. Meckel’s cave, can be removed via the same approach without enlarging the craniotomy.