Article
Endoscopic assisted surgery in posterior fossa lesions: results with 132 cases
Endoskopisch assistierte Chirurgie in der hinteren Schädelgrube: Ergebnisse mit 132 Fällen
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Authors
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J. Oertel
- Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Hannover, Deutschland
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M. R. Gaab
- Klinik für Neurochirurgie, Krankenhaus Hannover Nordstadt, Hannover, Deutschland
| Published: | May 30, 2008 |
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Outline
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Objective: The indication for endoscopic assisted surgery in skull bases lesions is under controversial discussion. Experienced skull base surgeons often consider the endoscope to be unnecessary while a younger generation of surgeons counts on the value of the endoscope in such procedures. Here, we present our series of endoscope assisted procedures in posterior fossa lesions performed since February 2003.
Methods: During the investigated time period, a total of 132 posterior fossa skull base cases were operated on using the endoscope. The endoscope was not routinely applied but only when it was felt to be helpful in each individual case. The application of the endoscope was evaluated with respect to the frequency and the duration of the assistance and with respect to the subjective value for the individual surgeon. All patients were followed postoperatively. In all cases, an early postoperative MRI was performed for resection control.
Results: The 132 skull base cases included 88 vestibular neurinomas, four trigeminal neurinomas, sixteen cerebello pontine angle meningiomas, four arachnoid cysts, seven hemifacial spasms, seven trigeminal neuralgias, and six epidermoids. Overall the endoscope was considered to be helpful in 106 of 132 cases (80%). It was considered to be indispensable in 19 cases (14%). In vestibular neurinomas, the endoscope was used for inspection in 72 cases (82%) and for endoscopic assistance in 16 (18%). The technique was considered to be indispensable in high jugular bulb and deep intrameatal tumour. The endoscope was considered helpful in 64 (73%) and indispensable in thirteen (15%). In hemifacial spasm, the endoscope was used in 100% for inspection and was considered to be helpful in all cases. In epidermoids, the endoscope was used for assistance in 100% and considered to be indispensable in all (100%). In lesions, extending deep into Meckel’s cave (8 cases), the endoscope was also applied in 100% for assistance and considered to be helpful in all (100%).
Conclusions: In all, the authors consider endoscopic assistance to be a valuable tool in selected cases of skull base lesions in the posterior fossa. The technique appears to be particularly helpful in neurinomas with deep intrameatal extension, lesions extending into Meckel’s cave and in large epidermoids in the posterior fossa.
