A long-term retrospective study of 300 patients who underwent fully endoscopic endonasal pituitary adenoma resection between November 1998 and October 2004. The patients' records as well as the data obtained from postoperative follow-up visits was used to determine outcomes. Additionally, the data were then compared to mean values calculated from several transseptal-transsphenoidal reports. From a total of 300 pituitary adenomas, 139 (46 %) were hormonally active, while 161 (54 %) were non-functioning. Mean follow-up period was 38.2 months. The average length of hospital stay (LOS) was 1.4 days. All patients had postoperative magnetic resonance imaging (MRI) studies to assess residual or recurrent disease; all patients with hormonally active tumors had additional postoperative hormonal studies. Remission, being defined as no hormonal or radiological evidence of recurrence within the time-frame of the follow-up, was demonstrated in 127/134 (95 %) of enclosed and 144/166 (87 %) of invasive adenomas. A comparison of fully endoscopic endonasal vs. transseptal-transsphenoidal remission results revealed an improved outcome using the fully endoscopic endonasal technique: ACTH (86 % vs. 81 %), PRL (89 % vs. 66 %) and GH (85 % vs. 77 %). The remission rate for non-functioning adenomas was 149/161 (93 %). Additionally, we noted a marked reduction in complications related to the endoscopic procedure. Our results conclude that the fully endoscopic endonasal technique is a safe and effective method for removal of pituitary adenomas providing more complete tumor removal and reducing complications.

Early detection and treatment of craniofacial and skull base traumatic injuries should lead to decreased morbidity and mortality. This review discusses the most common of these injuries, their possible complications, and treatment.

Microvascular decompression of the trigeminal nerve is an accepted and effective means of treating patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. The current standard technique uses the binocular operating microscope for all intra-operative visualization. Posterior fossa endoscopy has demonstrated that the endoscope provides more comprehensive views of the anatomy of the cerebellopontine angle than does the operating microscope. To date, endoscopy has only been used to supplement microscopy in cranial nerve decompression surgery. In this report, we describe our completely endoscopic surgical technique as we present the case of a patient with trigeminal neuralgia who underwent successful vascular decompression by this approach. Using this technique the offending vessel was separated from the nerve with minimal brain retraction or dissection of surrounding structures. This report represents the first documented case where the endoscope was used as the exclusive imaging modality for decompression of the trigeminal nerve. From our experience we conclude that the endoscope's superior visualization more accurately identifies neurovascular conflicts, and provides a comprehensive evaluation of the completeness of the decompression. Additionally, this new method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. From this study we conclude that completely endoscopic vascular decompression represents the next step forward in the safe and effective surgical treatment of trigeminal neuralgia.

Microvascular decompression (MVD) is a highly accepted and effective method for treatment of patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. However, recent reports have highlighted the advantages of the endoscope in visualizing structures within the cerebellopontine angle. Additional research, using the endoscope to supplement the microscopic procedure, has demonstrated improved localization of neurovascular conflicts. In this report we present the results of our series utilizing a fully endoscopic vascular decompression (EVD) technique, and compare these results to those published for microvascular decompression. From September 1999 until October 2004, 255 patients underwent endoscopic vascular decompression of the trigeminal nerve. These patients' records were retrospectively reviewed, and additional data from follow-up visits were collected and analyzed to ascertain success rates and review the incidence of complications. From a total of 255 patients who underwent EVD of the trigeminal nerve we noted an initial, complete, postoperative success rate in 95 % of patients. Initial, being defined as within the first 3 months postoperative, and "complete" being judged if the patient reported 98 % relief of pain postoperatively without the need for medication (Barker's classification). Additionally, we documented a 93 % complete success rate for 118 patients who completed at least a three-year follow-up period. Complication rates were compared to those reported for MVD. There were no serious complications or mortality in this series. We conclude that EVD is a safe and effective method to remove neurovascular conflicts related to the trigeminal nerve. The results of this series demonstrate an improved rate of trigeminal neuralgia relief with EVD when compared to MVD, a lower incidence of complications and a better outcome.

No abstract

No abstract

New applications for intracranial endoscopic surgery continue to evolve. The endoscope provides improved visualization of the skull base, where narrow recesses and angled trajectories impair the direct forward view of the operating microscope. Endoscopic surgery allows for a smaller craniotomy, less dissection and minimal retraction, without compromising the goals of the operation. Articles describing the use of angled endoscopes to assist microscopic removal of vestibular schwannomas suggest that endoscopes allow for complete visualization of the most lateral aspect of the internal auditory canal, identify exposed air cells, and provide more detailed images of the surrounding neurovascular structures. In this report we describe three fully endoscopic excisions of 2 - 3.5 cm vestibular schwannomas via 1.5 cm keyhole retrosigmoid craniotomies. The 0 degrees and 30 degrees endoscopes provided excellent exposure, allowing complete visualization of the most lateral aspect of the internal auditory canal, insuring complete tumor removal. The patients had excellent outcomes and were discharged within 72 hours post-operatively. From our experience we conclude that the endoscope is ideally suited for a minimally invasive retrosigmoid approach to vestibular schwannomas.

Microvascular decompression of the glossopharyngeal nerve is an effective treatment of patients with glossopharyngeal neuralgia in whom compression of the nerve by a blood vessel is implicated in the pathogenesis of the disease. The standard surgical technique uses a binocular operating microscope for intra-operative visualization. Growing experience with posterior fossa endoscopy, however, has suggested that endoscopes may provide more comprehensive anatomical views of cerebellopontine angle. This report describes the case of a patient suffering from glossopharyngeal neuralgia who underwent fully endoscopic vascular decompression of the glossopharyngeal nerve. During this procedure the endoscope was used to survey the posterior fossa, guide the placement of insulating sponges, and conduct a final assessment of the intervention. We found the endoscope ideally suited to the constricted operating space of the posterior fossa, allowing for accurate localization and careful separation of the pathological vascular conflict with minimal brain retraction and no damage to surrounding structures. The versatility of endoscopy allows for superior visual appreciation of neurovascular conflicts in the posterior fossa. To date, endoscopy has primarily been used to supplement microscopy in cranial nerve decompression surgery. This report demonstrates how the endoscope can be used as the sole imaging modality in glossopharyngeal nerve decompression, with excellent results.