Quantitative analysis of surgical exposure and maneuverability associated with the endoscope and the microscope in the retrosigmoid and various posterior petrosectomy approaches to the petroclival region using computer tomograpy-based frameless stereotaxy. A cadaveric study

Tang, Chi Tun; Kurozumi, Kazuhiko; Pillai, Padmanabhan; Filipče, Venko; Chiocca, E. Antonio; Ammirati, Mario

doi:10.1016/j.clineuro.2012.10.023

Cited by 26 publications

(17 citation statements)

References 13 publications

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“…In cadaveric studies, quantitative analysis has demonstrated a nearly 2-fold increase in the view of the endoscope compared with the microscope. 35 This enhanced visualization has, in our experience and in commentary of other surgeons, allowed for a greater anatomical exposure that enables an increased ability to locate nerve-vessel conflicts that are limited with the microscope vantage point. 4 While the endoscope has been adopted by neurosurgeons as an adjunct to microsurgery in the posterior fossa, there are limited data on fully endoscopic microvascular decompression (E-MVD) for HFS.…”

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confidence: 85%

Fully endoscopic microvascular decompression for hemifacial spasm

Flanders

Blue

Roberts

et al. 2019

Journal of Neurosurgery

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OBJECTIVEHemifacial spasm (HFS) is characterized by involuntary tonic and/or clonic contractions of facial nerve muscles. Fully endoscopic microvascular decompression (E-MVD) for HFS has not been widely adopted. This paper aims to illustrate the safety and efficacy of the fully endoscopic technique for HFS treatment.METHODSThe authors conducted a single-center retrospective study of 27 patients (28 separate E-MVD cases; 1 patient had bilateral E-MVD) diagnosed with HFS who underwent fully E-MVD from January 2013 to October 2016. Intraoperative brainstem auditory evoked potentials and lateral spread resolution were reviewed. Outcome was based on the clinical status of the patient at the last contact point with the senior author. Complications were categorized as facial weakness, hearing loss, ataxia, dysphagia, or any adverse event able to be attributed to the surgical procedure.RESULTSHFS was relieved either completely or partially in the majority of cases (24 of 28, 85.7%). Of the 28 separate procedures, 17 (60.7%) resulted in complete resolution of symptoms, 4 (14.3%) resulted in near-complete resolution, 2 (7.1%) resulted in 50% reduction of symptoms, 1 (3.6%) resulted in minimal reduction, and 4 (14.3%) resulted in no relief. Of the 27 patients, 26 (96%) had no permanent postoperative complications. In multivariate logistic regression, the best predictor of greater than 50% resolution of spasm was resolution of intraoperative lateral spread response.CONCLUSIONSA fully E-MVD for HFS provides a safe and comprehensive view of the neurovascular conflict. Exclusive use of the endoscope in MVD is both safe and feasible in the treatment of HFS. Attention to lateral spread response monitoring remains an integral part of comprehensive neurosurgical management.

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confidence: 85%

Fully endoscopic microvascular decompression for hemifacial spasm

Flanders

Blue

Roberts

et al. 2019

Journal of Neurosurgery

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“…Multiple anatomic studies have evaluated the differences in the exposure provided by different surgical approaches. [7][8][9][10] These studies had a small sample size; therefore, their findings are not generalizable. Also, none of the studies examined the effects of the anatomic variability on the formation of different anatomic patterns of the petroclival region.…”

Section: Discussionmentioning

confidence: 95%

Morphometric Study of the Posterior Fossa: Identification of Practical Parameters for Tailored Selection of Surgical Routes to the Petroclival Region

Aljuboori

Alhourani

Nuru

et al. 2020

J Neurol Surg B Skull Base

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Introduction The petroclival region is an integral part of the skull base. It can harbor different pathologies and provides access to the petroclival junction and cerebellopontine angle. We present the results of the morphometric analysis of the posterior fossa and a prediction model to enable skull base surgeons to choose an optimal surgical corridor considering patient's bony anatomy. Methods Ninety patients (14 to assess interobserver reliability) with temporal bone computed tomography were selected. Exclusion criteria included patients <18 years of age, radiographic evidence of trauma, infection, or previous surgery. The images were analyzed using OsiriX MD (Bernex, Switzerland). We recorded clival length, vertical angle, and surface area, and petroclival angle, petrous apex, and translabyrinthine corridors volume. Results The average age was 49.5 years (55%) for males. The mean clival length and surface areas were 44.2 mm (standard deviation [SD] ± 4.1) and 8.1 cm2 (SD ± 1.3). The mean petrous apex and translabyrinthine corridors volumes were 2.2 cm3 (SD ± 0.6) and 10.1 cm3 (SD ± 3.7). The mean petroclival angle at the internal auditory canal (IAC) was 154.9 degrees (SD ± 9). The clival length correlated positively with clival surface area (rho = 0.6, p <0.05), petrous apex volume (rho = 0.3, p < 0.05), and translabyrinthine volume (rho = 0.3, p < 0.05). Conclusion The petroclival region is complex and with high variability of surgical significance. The use of preoperative measurements of the clival length and petroclival angle as part of surgical planning that could help the surgeon to choose an optimal surgical corridor by overcoming the anatomical variability elements.

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“…Previous quantitative comparative studies revealed that the endoscopic-assisted technique can achieve a greater exposure or viewable area than using conventional microscopic open access [ 11 - 12 ]. However, endoscope assistance is limited by a decrease or at least significant impediments in maneuverability when compared with using the operative microscope [ 13 ]. High-quality videos and feasibility in many neurosurgical scenarios have made the endoscope a popular additional visualization tool in neurosurgical practice.…”

Section: Discussionmentioning

confidence: 99%

Laboratory Evaluation of a Robotic Operative Microscope - Visualization Platform for Neurosurgery

Belykh¹,

Zhao²,

Cavallo³

et al. 2018

Cureus

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BackgroundWe assessed a new robotic visualization platform with novel user-control features and compared its performance to the previous model of operative microscope.MethodsIn a neurosurgery research laboratory, we performed anatomical dissections and assessed robotic, exoscopic, endoscopic, fluorescence functionality. Usability and functionality were tested in the operating room over 1 year.ResultsThe robotic microscope showed higher sensitivity for fluorescein sodium, higher detail in non-fluorescent background, and recorded/presented pictures with color quality similar to observation through the oculars. PpIX visualization was comparable to the previous microscope. Near-infrared indocyanine green imaging 3-step replay allowed for more convenient accurate assessment of blood flow. Point lock and pivot point functions were used in dissections to create 3D virtual reality microsurgical anatomy demonstrations. Pivot point control was particularly useful in deep surgical corridors with dynamic retraction. 3D exoscopic function was successfully used in brain tumor and spine cases. Endoscopic assistance was used for around-the-corner views in minimally invasive approaches. We present illustrative cases highlighting utility and new ways to control the operative microscope.ConclusionImprovements of the robotic visualization platform include intraoperative fluorescence visualization using FNa, integrated micro-inspection tool, improved ocular imaging clarity, and exoscopic mode. New robotic movements positively assist the surgeon and provide improved ergonomics and a greater level of intraoperative comfort, with the potential to increase the viewing quality. New operational modes also allow significant impact for anatomy instruction. With the increasing number and complexity of functions, surgeons should receive additional training in order to avail themselves of the advantages of the numerous novel features.

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Quantitative analysis of surgical exposure and maneuverability associated with the endoscope and the microscope in the retrosigmoid and various posterior petrosectomy approaches to the petroclival region using computer tomograpy-based frameless stereotaxy. A cadaveric study

Cited by 26 publications

References 13 publications

Fully endoscopic microvascular decompression for hemifacial spasm

Fully endoscopic microvascular decompression for hemifacial spasm

Morphometric Study of the Posterior Fossa: Identification of Practical Parameters for Tailored Selection of Surgical Routes to the Petroclival Region

Laboratory Evaluation of a Robotic Operative Microscope - Visualization Platform for Neurosurgery

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