Article
What is the role of endoscope during microsurgery in the posterior cranial fossa?
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Authors
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Guilherme Ramina Montibeller
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar, Deutschland
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Michael R. Gaab
- Klinik für Neurochirurgie, KRH Klinikum Nordstadt, Hannover, Deutschland
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Joachim Oertel
- Klinik für Neurochirurgie, Universitätskliniken des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg/Saar, Deutschland
| Published: | May 21, 2013 |
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Outline
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Objective: During surgery in the posterior cranial fossa, neuro-endoscopy may be important giving additional information to the microscopic view. The aim of this study is to observe the relevance of this technique while treatment of different pathologies in this area.
Method: Between February 2003 and December 2010 139 Patients were operated on pathologies in the posterior cranial fossa and the neuro-endoscope with different angle optics was used as an adjunctive tool for inspection or in some fewer cases for endoscopic-assisted surgery. Surgical reports, diagnostic imaging and intraoperative video-recordings were retrospectively analysed. The presence of remnant tumor after resection with the microscope, the identification of nerve-compressing vessels and the early recognition of nerves and other structures as well as possible advantages of the technique were evaluated.
Results: Vestibular schwannomas, epidermoid tumors, hemifacial spasms between other pathologies where operated on in the posterior cranial fossa. In the most part of cases the endoscope was used for inspection and around 1/5 of the cases for endoscopic-assisted surgery. Some identified advantages of this technique were the reduction of retraction of structures and the possibility to perform smaller craniotomies. After microsurgical resection of vestibular schwannomas, intrameatal remnant tumor was found in 13% of cases during final endoscopic inspection. Except in one case were an additional vein was found, the use of endoscopy during decompression of the trigeminal nerve in patients with trigeminal neuralgia, did not bring new information in our series of cases. Endoscopic inspection and endoscopic-assisted tumor resection revealed to be of great support in epidermoid tumor surgeries of posterior cranial fossa finding remnant tumor and reaching difficult and delicate areas. The additional time for the use of this technique is in our opinion very difficult to calculate once that some information given through endoscopy may even shorten the operation.
Conclusions: The role of the endoscope in skull base surgery becomes more and more obvious with time. Endoscopy during microsurgery in the posterior cranial fossa provides considerable advantages in some demanding situations. The additional time for the use of this technique cannot be calculated.
