Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience

Abstract

The endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.

Endoscope-assisted microsurgical retrosigmoid approach to the lateral posterior fossa: Cadaveric model and a review of literature

“…However, this procedure was associated with a risk of failure, recurrence, and neurological deficits. [ 5 , 8 , 16 , 19 , 20 , 25 , 27 , 39 , 42 ] The desire for safe minimally invasive approaches to the posterior fossa has led to the application of endoscopic techniques for nerve decompression from compressing vasculature. [ 6 ] Visualization of the entire cisternal facial nerve segment, often obstructed by both the flocculus and choroid plexus emanating from the foramen of Luschka, is possible with the use of endoscopes.…”

“…[ 14 , 43 ] The key factors for a successful MVD surgery include a precise visualization of all the nerve-vessel conflicts and a confirmation of a proper nerve decompression by the end of the procedure. [ 39 ] Given the anatomy of the posterior fossa and the limited size of the craniotomy, adequate visualization of the full course of the facial nerve and the porus portion, is difficult and challenging by the utilization of the surgical microscope only. [ 19 , 20 , 25 , 39 ] To overcome such limitations, endoscope-assisted microscopic surgery was introduced to properly identify the site of the neurovascular compression and reduce the risk of complications.…”

“…[ 39 ] Given the anatomy of the posterior fossa and the limited size of the craniotomy, adequate visualization of the full course of the facial nerve and the porus portion, is difficult and challenging by the utilization of the surgical microscope only. [ 19 , 20 , 25 , 39 ] To overcome such limitations, endoscope-assisted microscopic surgery was introduced to properly identify the site of the neurovascular compression and reduce the risk of complications. [ 1 , 4 , 15 , 24 , 28 , 30 , 34 , 39 ] Endoscope-assisted MVD of the facial nerve demonstrated an additional 72 % accuracy rate in identifying the nerve-vessel conflicts without dislocation of the acoustic-facial bundle and significant cerebellar retraction, resulting in a lower risk of neurological deficits.…”

“…[ 19 , 20 , 25 , 39 ] To overcome such limitations, endoscope-assisted microscopic surgery was introduced to properly identify the site of the neurovascular compression and reduce the risk of complications. [ 1 , 4 , 15 , 24 , 28 , 30 , 34 , 39 ] Endoscope-assisted MVD of the facial nerve demonstrated an additional 72 % accuracy rate in identifying the nerve-vessel conflicts without dislocation of the acoustic-facial bundle and significant cerebellar retraction, resulting in a lower risk of neurological deficits. [ 4 , 15 , 24 , 28 , 30 ]…”

A minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal: a step by step description

“…In this article we describe the endoscope assisted minimally invasive retro-sigmoid approach (EAMIRSA) for surgical removal of ACs in the IAC. The EAMIRSA has been successfully used by our group and others to treat different IAC pathologies 11 , 12 , 13 , 14 , 15 and vascular loop compressions on the facial 14 and cochlear nerve. 13 We propose to use the EAMIRSA for AC removal and in this article we describe the steps of the surgical procedure, which we tested on human cadaveric models (specimen) of subjects with AC in the IAC.…”