Combined microsurgical and endoscopic technique for removal of extensive intracranial epidermoids

Abstract

Background:Intracranial epidermoid tumors are challenging lesions because they grow along the subarachnoid spaces around delicate neurovascular structures and often extend from one compartment to another. The purpose of this study was to determine the usefulness of endoscopic assistance in the microsurgical resection of these lesions, in which total resection is therapy of choice.Methods:A total of 48 cases of intracranial epidermoids were treated by combined microscopic and endoscopic techniques. Initially, the tumor was removed under the microscope and after ensuring maximum excision, the endoscope was used to find out and excise any residual tumor.Results:Out of these 48 cases complete excision was achieved in 44 cases and subtotal excision in four patients. Postoperative complications were seen in 17 patients, but none of the complications was attributed to the use of endoscope. Overall use of endoscope benefited 79% of cases.Conclusion:We recommend combined microsurgical and endoscopic approach to achieve complete/maximum resection of extensive intracranial epidermoid tumors.

Analysis of giant intraventricular and extraventricular epidermoids, defining risk factors for recurrence, an institutional experience

“…reported 79% benefit in complete resection of the lesion which is in accordance with the findings of the present study. [ 24 25 26 ] In the current study, the number of cases with multicompartmental spread was more compared to other studies where staged operation was required. Multistage operation with good exposure of the lesion results in lesser recurrence as compared to incomplete exposure in single-stage surgery as demonstrated in many studies.…”

Role of the apparent diffusion coefficient as a predictive factor for tumor recurrence in patients with intracranial epidermoid tumor

“…A recent meta-analysis reported that the recurrence rate of intracranial epidermoid tumors is roughly one in ten patients, and some studies showed no recurrence even after subtotal resection [8]. However, several studies included in that meta-analysis obtained follow-up imaging only when symptoms occurred and did not perform MRI annually, which might make their interpretation problematic [2,19,26]. In the current study, we annually repeated MRI studies to radiologically screen for tumor recurrence, and we found that most STR cases do recur, most recurrences occurring within 2 years of surgery.…”

Rotitome-G: Principles and design concept of experimental compliant continuum robotic microsurgical endoscopic sarcotome for pixel/voxel-level target access neurosurgery

“…The objective end of an endoscope is very close to the workpiece and has a sharp convergent light beam. It improves visibility by illuminating the hard-to-access peripheral space of a tumour cavity, improving surgeon satisfaction and patient-based outcomes (Singh et al, 2018;Tammam et al, 2022;Tuchman et al, 2014). An exoscope provides an excellent view to perform superficial dissection and resect surface brain tumours (Kinoshita et al, 2021).…”