Neuroendoscopic anatomy and surgery of the cerebellopontine angle

The combined microscopic-endoscopic technique for radical resection of cerebellopontine angle tumors

“…6,7,14,23,33,43,46,47 The endoscope, especially with angled lenses, allows visualization of a residual lesion in locations not well seen through the microscope. The microscope is inherently limited in its angles of observation because its focal trajectory begins outside the field.…”

Minimally Invasive Endoscopic and Endoscopy-Assisted Microsurgery of Vestibular Schwannoma

“…Level 4 contains the lower medulla, spinal cord, spinal root of the accessory nerve and hypoglossal nerve. The majority of authors rather divide the region of cerebellopontine angle into three neurovascular complexes with no distinct borders (Rhoton, 2000a, Yuguang et al 2005. The upper complex is related to the superior cerebellar artery, a middle complex related to the anterior inferior cerebellar artery and a lower complex related to the posterior inferior cerebellar artery (Fig.1).…”

“…In addition, each neurovascular complex contains a group of cranial nerves. The upper neurovascular complex includes the superior cerebellar artery, midbrain, cerebellomesencephalic fissure, superior cerebellar peduncle, tentorial surface of the cerebellum, and the oculomotor, trochlear, and trigeminal nerves ( Fig.1) (Rhoton, 2000a, Cappabianca et al 2002, Yuguang et al 2005. The superior cerebellar artery (SCA) arises in front of the midbrain, usually from the basilar artery near its apex.…”

“…Understanding the anatomy of the middle neurovascular complex is crucial for the surgical treatment of vestibular schwannoma (Fig.1) (Rhoton, 2000a, Miyazaki et al 2005. The middle complex includes the anterior inferior cerebellar artery, pons, middle cerebellar peduncle, cerebellopontine fissure, petrosal surface of the cerebellum, and the abducens, facial, and vestibulocochlear nerves (Rhoton, 2000a, Cappabianca et al 2002, Yuguang et al 2005. The anterior inferior cerebellar artery (AICA) arises at the pontine level from the basilar artery, usually as a single trunk.…”

“…It should be preserved when elevating the dura and opening the canal if there is the possibility of preserving hearing. The lower neurovascular complex is related to the posterior inferior cerebellar artery, and includes the medulla, inferior cerebellar peduncle, cerebellomedullary fissure, suboccipital surface of the cerebellum, and the glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves (Fig.1) (Rhoton, 2000a, Cappabianca et al 2002, Yuguang et al 2005. The posterior inferior cerebellar artery (PICA) arises from the vertebral artery at the medullary level, encircles the medulla, passing in relationship to the lower cranial and hypoglossal nerves to reach the surface of the inferior cerebellar peduncle, where it dips into the cerebellomedullary fissure and terminates by supplying the suboccipital surface of the cerebellum (Rhoton 2000c).…”