Adjunctive Use of Endoscopy during Posterior Fossa Surgery to Treat Cranial Neuropathies

King, Wesley A.; Wackym, Phillip A.; Sen, Chandranath; Meyer, Glenn A.; Shiau, John S.; Deutsch, Harel

doi:10.1097/00006123-200107000-00017

Cited by 29 publications

(35 citation statements)

References 28 publications

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“…The endoscope has quickly become a standard operative tool in minimally invasive neurosurgery of the sella and ventricular system due to the panoramic views and bright illumination [4–6]. Similarly, advantages of the endoscope in visualizing structures within the cerebellopontine angle (CPA), including nerve cleavage planes and vascular anatomic features, have been noted in addition to smaller exposures and less cerebellar or brainstem retraction than conventional microscopy [7, 8]. The endoscope has been reported to be used as a standard adjunct to conventional MVD in a number of institutions, but rarely as a solo technique [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Fully Endoscopic Microvascular Decompression: Our Early Experience

Halpern

Lang

Lee

2013

Minimally Invasive Surgery

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Background. Microvascular decompression (MVD) is a widely accepted treatment for neurovascular disorders associated with facial pain and spasm. The endoscope has rapidly become a standard tool in neurosurgical procedures; however, its adoption in lateral approaches to the posterior fossa has been slower. The endoscope is used primarily to assist conventional microscopic techniques. We are interested in developing fully endoscopic approaches to the cerebellopontine angle, and here, we describe our preliminary experience with this procedure for MVD. Methods. A retrospective review of our two-year experience from 2011 to 2012, transitioning from using conventional microscopic techniques to endoscope-assisted microsurgery to fully endoscopic MVD, is provided. We also reviewed our preliminary outcomes during this transition. Results. There was no difference in the surgical duration of these three procedures. In addition, the majority of procedures performed in 2012 were fully endoscopic, suggesting the ease of incorporating this solo tool into practice. Pain outcomes of fully endoscopic MVD appear to be very similar to those of both conventional and endoscope-assisted MVDs. Complications occurred in all groups at equally low rates. Conclusion. Fully endoscopic MVD is both safe and effective. By enhancing visualization of structures within the cerebellopontine angle, endoscopy may prove to be a valuable adjunct or alternative to conventional microscopic approaches.

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Section: Introductionmentioning

confidence: 99%

Fully Endoscopic Microvascular Decompression: Our Early Experience

Halpern

Lang

Lee

2013

Minimally Invasive Surgery

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“…Endoscopy, by comparison, is equally effective as the microscope when viewing superficial objects at low magnification but is associated with no decrease in light intensity when visualizing deep-seated structures. 15,26 Also, the mobility of the endoscope as a visualization tool, along with the versatility that may be added with an angled lens, eliminates the restriction of a narrow viewing angle, permitting surgeons to safely view objects that are not in a direct line of sight. Therefore, our ability to both determine the presence of a cleavage plan between the vestibular and cochlear components of cranial nerve VIII, as well as to confirm the location of cranial nerve VII anteriorly, was significantly improved with endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…King et al 15 examined the utility and safety of rigid endoscopy as an adjunct to the microscope in 8 patients who underwent vestibular nerve sectioning via a retrosigmoid approach for treatment of unilateral Ménière disease. A 0° or 30° rigid endoscope was used in conjunction with the microscope for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…36 The endoscopic-assisted vestibular nerve sectioning procedure, in which the endoscope is used as a visualization adjunct to the microscope, has been well described previously. 15,19,23,36 The traditional design of the rigid endoscopes in these studies-consisting of either a lens, light source, and working channel within which instruments may be introduced or else of a lens and light source only with instruments used in parallel-requires there be either a cosurgeon to hold the endoscope or that it be fixed to the operating table. In this report, we introduce a single-operator (2-handed) endoscopic-directed approach for vestibular nerve sectioning, with a novel modification to the traditional endoscope.…”

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confidence: 99%

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Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature

Cutler

Kaloostian

Ishiyama

et al. 2012

JNS

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ObjectVestibular nerve sectioning is an accepted surgical treatment option for patients with medically refractory Ménière disease. In this paper the authors introduce and evaluate a 2-handed endoscopic-directed technique for vestibular nerve section.MethodsEleven patients underwent a retrosigmoid craniectomy for endoscopic-directed vestibular nerve sectioning as treatment for intractable vertigo associated with Ménière disease. In all patients, identification and dissection of the cranial nerve VII/VIII complex was performed entirely under endoscopic guidance. The authors used the specially designed Frazee II neuroendoscope, consisting of a traditional endoscope lens with a microsuction attachment.ResultsVestibular nerve sectioning was completed in all 11 patients. Postoperative improvement in vertiginous episodes was achieved in 10 patients (91%). Auditory function was noted to be worse postoperatively in only 1 patient (9%). The same patient also developed a House-Brackmann Grade III facial nerve palsy, which improved gradually over time. There were no further complications, including no delayed CSF leaks.ConclusionsThe endoscopic-directed approach represents a safe and effective method for performing vestibular nerve sectioning. Until now, the endoscope has been used primarily as an adjunct to the operating microscope in surgery at the cerebellopontine angle. In addition, previous endoscopic techniques typically require a third hand to manipulate the endoscope. With the 2-handed endoscopic-directed technique, however, the endoscope is used as the primary means of visualization, and the unique design of this endoscope allows for a bimanual procedure without the requirement of a cosurgeon. Advantages of using this technique compared with the microscope include superior brightness at close distances, greater depth of field, increased maneuverability within small regions, and an improved ability to visualize objects not in a direct line of sight. Among other things, this allows for minimally invasive openings, decreased cerebellar retraction, and better identification of nerve cleavage planes and vascular anatomy.

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“…Previously, the space-occupying lesion located in Meckel cave had been mainly treated with radiotherapy and craniotomy. During the last several decades, the endoscopic techniques have been gradually applied and extended, especially after the endonasal approach has been expanded, the advantages of endoscopic and surgical indications have received further recognition [2]–[7] and the application scope of endoscopic nasal approach has been gradually broadened. In the present study, we performed an anatomical analysis on Meckel cave of fresh human skulls perfused with red latex using endoscopic endonasal, endo-maxillary sinus, and endo-pterygoid process approach to investigate the anatomical characteristics of Meckel cave and the feasibility of using these approaches to study Meckel cave, aiming to provide anatomical basis for the application of endoscopic endonasal approach for the surgical treatment of the space-occupying lesions in Meckel cave.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Study on Meckel Cave with Endoscopic Endonasal, Endo-Maxillary Sinus, and Endo-Pterygoid Process Approaches

Wang

Cai

et al. 2014

PLoS ONE

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ObjectiveTo study anatomical structures related to Meckel cave with endonasal endoscopic approach and to provide an anatomical basis for endoscopic surgery in Meckel cave.MethodsMeckel cave of 5 adult skulls (10 sides) were fixed with 10% formalin. The anatomical structures of Meckel cave and the related zones adjacent to Meckel cave were observed and measured with endoscopic endonasal approach.ResultsEndoscopic endonasal, endo-maxillary sinus, and endo-pterygoid process approaches were successfully applied in observation of the anatomical structures of meckel cave and the rerated zones adjacent to Meckel cave and in measurement of distances between related anatomical structures for each case of samples. The relevant data were obtained. The distance between the front mouth of palatovaginal canal and vidian canal was 21.4±7 mm, the distance between opening of sphenoid sinus to the upper margin of the choana was 22.3±2.8 mm, the distance between the opening of vidian and foramen rotundum was 7.57±0.7 mm and the length of the pterygoid canal was 13.3±1.2 mm. Based on these data, the positions of the related important structures can be roughly located during surgical operation and various important structures in Meckel cave and its adjacent zones can be found out in a convenient and safe way.Conclusion1) It is feasible to use endonasal endoscopic approach to perform surgical operation in Meckel cave; 2) Use of endonasal endoscopic approach can protect and fully take the advantage of the vidian nerve to locate the position of foramina lacerum of the internal carotid artery during surgical operation; and 3) the observational and experimental data obtained with this approach can provide the rational basis for clinical operation procedures.

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Adjunctive Use of Endoscopy during Posterior Fossa Surgery to Treat Cranial Neuropathies

Abstract: The rigid endoscope can be used safely during posterior fossa surgery to treat cranial neuropathies, and it allows improved observation of the cranial nerves, nerve cleavage planes, and vascular anatomic features without significant cerebellar or brainstem retraction.

Cited by 29 publications

References 28 publications

Fully Endoscopic Microvascular Decompression: Our Early Experience

Fully Endoscopic Microvascular Decompression: Our Early Experience

Two-handed endoscopic-directed vestibular nerve sectioning: case series and review of the literature

Anatomical Study on Meckel Cave with Endoscopic Endonasal, Endo-Maxillary Sinus, and Endo-Pterygoid Process Approaches

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