A New Powered Endoscope Holding Arm for Endoscopic Surgery of the Cranial Base

Abstract

Over the past 20 years endoscopy has become an essential part of nearly all surgical specialities. In the field of skull base surgery recent articles describe new applications and highlight improved results in pituitary adenoma removal, vascular decompression surgery, and in the resection of many other skull base tumors. The strength of the endoscope in skull base surgery lies in its ability to see behind bony apices and neurovascular structures, which normally obscure the view of the operating microscope. Paramount to the success of the endoscope in skull base and pituitary surgery is the ability to secure the arm in position. Operating in the confined spaces of the skull, the instability and difficult adjustment of currently available endoscope holding arms is cumbersome for the surgeon and dangerous to the patient. Many surgeons have commented that the currently available endoscope holding arms are inadequate for contemporary applications of endoscopic skull base surgery. In this article we describe a new pneumatically powered endoscope holding arm, which provides the level of stability and ease of adjustment necessary for current and future applications of endoscope skull base surgery.

Fully endoscopic microvascular decompression for trigeminal neuralgia: technique review and early outcomes

“…A Mitaka Pneumatic Arm (Mitaka Kohki Co.), which is firmly secured to the bed, was used for all cases. 9 We generally use a 2.7-mm outer diameter offset endoscope (Storz). The smaller diameter of this endoscope as opposed to the standard 4-mm sinus endoscope maximizes the available working space for the other instruments, minimizing both instrument clash and brain retraction.…”

Fully Endoscopic Excision of Vestibular Schwannomas

“…The fully endoscopic approach has been used for the microvascular decompression of the trigeminal nerve in patients with trigeminal neuralgia, of the facial nerve in patients with hemifacial spasm and of the glossopharyngeal nerve in patients with glossopharyngeal neuralgia. The fully endoscopic approach has also been used in the resection of many cerebellopontine angle tumors including meningiomas, schwannomas of the vestibular and trigeminal nerves, neurofibromas, epidermoids, cholesteatomas and CNS lymphomas [11,12] Other published reports have used this approach to clip saccular aneurysms of the vertebrobasilar system.…”

“…These articles suggest that the endoscope provides improved recognition of exposed air cells, and may allow for more complete tumor removal by direct visualization of the lAC to remove any residual tumor out of the view of the operating microscope [3,4,7]. Our group has been performing endoscope assisted or fully endoscopic surgery of the cerebellopontine angle (CPA) for trigeminal neuralgia, hemifacial spasm, and other CPA tumors since 1996 [11,12]. We began using the endoscope to supplement our microsurgical resection of vestibular schwannomas in 1998.…”

Use of a Nitrogen Arm-Stabilized Endoscopic Microdriver in Neuroendoscopic Surgery

“…A number of advances in optics, neuronavigational equipment, endoscopic instruments, and surgical techniques have resulted in an increase in the use of endoscopy for neurosurgical applications. Until recently [5], little progress had been made in stabilizing technology. As a result, many surgeons have continued to rely on manual scope positioning, citing difficulties with scope drift or awkward manipulation when using a positioning arm.…”