Endoscope-assisted Surgery for Acoustic Neuromas (Vestibular Schwannomas): Early Experience Using the Rigid Hopkins Telescope

Endoscope-assisted Surgery for Acoustic Neuromas (Vestibular Schwannomas): Early Experience Using... AbstractOBJECTIVEEndoscopes have been increasingly used during neurosurgical procedures. Previously, they have been shown to offer better visualization than the microscope in selected situations and frequently have allowed less invasive surgery. This study was undertaken to determine whether endoscopy is safe and effective during suboccipital surgery for vestibular schwannomas.METHODSTen patients with vestibular schwannomas underwent suboccipital transmeatal craniotomies for tumor excision. Endoscopy with a rigid glass lens endoscope (Hopkins telescope) was used during tumor removal to examine posterior fossa neurovascular structures and after tumor excision to inspect the internal auditory canal.RESULTSComplete tumor excision was achieved in nine patients. Endoscopy allowed improved identification of tumor and adjacent neurovascular relationships in all cases without the need for significant retraction of the cerebellum or brain stem. In addition, residual tumor at the fundus of the internal auditory canal (n = 2) and exposed petrous air cells (n = 3) not seen with the microscope were identified endoscopically. Operative time was not significantly increased by incorporating the endoscope.CONCLUSIONPosterior fossa endoscopy can be performed safely during surgery for tumor removal. Endoscope- assisted surgery for vestibular schwannomas may offer some advantages over standard microsurgery in selected cases. The advantages may include improved visualization, more complete tumor removal, and a lowered risk of cerebrospinal fluid leakage. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Endoscope-assisted Surgery for Acoustic Neuromas (Vestibular Schwannomas): Early Experience Using the Rigid Hopkins Telescope

Endoscope-assisted Surgery for Acoustic Neuromas (Vestibular Schwannomas): Early Experience Using the Rigid Hopkins Telescope

Endoscope-assisted Surgery for Acoustic Neuromas (Vestibular Schwannomas): Early Experience Using the Rigid Hopkins Telescope Wesley A. King, M .D ., Phillip A. Wackym, M .D. Departments of Neurosurgery and Otolaryngology, Mount Sinai School of Medicine, New York, New York OBJECTIVE: E n doscopes h a v e b e e n in c r e a s in g ly used d u r in g n e u r o s u r g ic a l p r o c e d u r e s . P r e v io u s ly , t h e y h a v e b e e n shown to o ff e r b e t t e r v i s u a l i z a t i o n t h a n t h e m ic r o s c o p e in s e le c te d s itu a tio n s a n d f r e q u e n t l y h a v e a l l o w e d less invasive s u rg e ry . T h is s tu d y w a s u n d e r t a k e n to d e t e r m i n e w h e t h e r e n d o s c o p y is safe a n d e f f e c t i v e d u r in g suboccipital s u rg e ry f o r v e s t i b u la r s c h w a n n o m a s . M E T H O D S : T e n p a tie n ts w i t h v e s t ib u la r s c h w a n n o m a s u n d e r w e n t s u b o c c ip it a l t r a n s m e a t a l c r a n i o t o m i e s f o r t u ­ mor excision . E n d o s c o p y w i t h a rig id glass lens e n d o s c o p e ( H o p k in s te le s c o p e ) w a s used d u r in g t u m o r r e m o v a l to e x a m in e p o s t e r io r fossa n e u r o v a s c u l a r s tru c tu r e s a n d a f t e r t u m o r e x c is io n to in s p e c t t h e in t e r n a l a u d i t o r y canal. RESULTS: C o m p l e t e t u m o r e x c is io n w a s a c h ie v e d in n in e p a tie n ts . E n d o s c o p y a l l o w e d i m p r o v e d i d e n t i f i c a t i o n o f tu m o r an d a d j a c e n t n e u r o v a s c u l a r r e la tio n s h ip s in all cases w i t h o u t t h e n e e d f o r s ig n ific a n t r e t r a c t i o n o f th e c e re b e llu m o r b r a in s te m . In a d d i t i o n , re s id u a l t u m o r a t th e fu n d u s o f th e in t e r n a l a u d i t o r y c a n a l (n = 2 ) a n d exposed p e tro u s a i r cells (n = 3) n o t seen w i t h th e m ic r o s c o p e w e r e id e n t if...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199905000-00084
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEEndoscopes have been increasingly used during neurosurgical procedures. Previously, they have been shown to offer better visualization than the microscope in selected situations and frequently have allowed less invasive surgery. This study was undertaken to determine whether endoscopy is safe and effective during suboccipital surgery for vestibular schwannomas.METHODSTen patients with vestibular schwannomas underwent suboccipital transmeatal craniotomies for tumor excision. Endoscopy with a rigid glass lens endoscope (Hopkins telescope) was used during tumor removal to examine posterior fossa neurovascular structures and after tumor excision to inspect the internal auditory canal.RESULTSComplete tumor excision was achieved in nine patients. Endoscopy allowed improved identification of tumor and adjacent neurovascular relationships in all cases without the need for significant retraction of the cerebellum or brain stem. In addition, residual tumor at the fundus of the internal auditory canal (n = 2) and exposed petrous air cells (n = 3) not seen with the microscope were identified endoscopically. Operative time was not significantly increased by incorporating the endoscope.CONCLUSIONPosterior fossa endoscopy can be performed safely during surgery for tumor removal. Endoscope- assisted surgery for vestibular schwannomas may offer some advantages over standard microsurgery in selected cases. The advantages may include improved visualization, more complete tumor removal, and a lowered risk of cerebrospinal fluid leakage.

Journal

NeurosurgeryOxford University Press

Published: May 1, 1999

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