gms | German Medical Science

Objective: Exposure of the entire resection cavity after removal of brainstem or cerebellum deep-seated lesions may be difficult using the straight-line view of the microscope. The aim of this study is to assess the importance of endoscopy during surgery of lesions in these areas.

Method: Fourteen consecutive surgeries (2007 - 2014) of patients with an intraparenchymal lesion of the brain stem or cerebellum in which a neuroendoscope was additionally used were retrospectively analyzed. Surgeries were mainly performed using an operating microscope (OPMI Pentero, Zeiss Company, Oberkochen, Germany). Neuroendoscopes (4 mm rigid with 0°, 30° and 70° optics; Karl Storz Company, Tuttlingen, Germany) were used as an adjunctive tool for inspection of the resection cavity. Surgical reports, diagnostic imaging and intraoperative video-recordings were assessed. Field of vision, presence of remnant tumor and existence of bleeding spots after resection with the microscope were evaluated.

Results: All cases (7 cavernous hemangiomas and 7 hemangioblastomas) were operated on through the retrosigmoid approach. In order to decrease risk of injury, brainstem and cerebellar incision was kept as small as possible. Endoscopy helped exposing the whole resection cavity after microscopic surgery in all cases. Remnant tumor was found in one case of brainstem hemangioblastoma during final endoscopic inspection. Further resection was performed under endoscopic view. New bleeding spots, not depicted with the microscope, were not observed in these series. There were no complications related to the use of the endoscope.

Conclusions: After removal of deep-seated lesions in the brainstem and cerebellum, the resection cavity frequently assumes a balloon-like shape. Complete exposure of the operative field is not always possible using the straight-line view of the microscope. The adjunctive use of the neuroendoscope revealed to be a safe and important option for inspection in these situations.