Endoscopic and endoscopically assisted surgeries for posterior cranial fossa lesions.

Abstract

Background: posterior cranial fossa basal lesions including tumors and vascular compression syndromes especially located in cerebellopontine angles (CPA) are considered one of the most complex regions due to crowded anatomy and limitations of visualization during surgery by the microscope alone, so endoscopic use as assisted visualization technique helps greatly in achieving good results, better outcomes and less morbidities. The aim of this work is to assess endoscopic role and importance as assisted tool during microscopic surgery for those lesions in neurosurgery Department in Zagazig University Hospitals from October 2016 to October 2018. Methods: 33 patients included 5 cases of epidermoid, 8 cases of acoustic Schwannomas, 4 meningiomas, 10 cases of Hemifacial spasm and 6 cases of trigeminal neuralgia. in this study we used the endoscope as assisted tool to the microscope, initial dissection by the microscope then the endoscope was used to navigate in the area to detect and demonstrate the pathology and its relations to the surrounding structures, then most of the work is microscopic and the endoscope is used in different stages to detect any residuals of tumors, hidden parts, any injuries, may be used to dissect in some situations if needed, position of insulators in microvascular decompression and final view after finishing the surgery. Results: Endoscopy provided improved visualization of local anatomy, revealed hidden lesions and reduced unnecessary anatomical distortions.Conclusion: endoscopic aided technique greatly helps surgical management of CPA lesions and other disorders. This minimally invasive technique overcomes many shortcomings inherent to the traditional retrosigmoid approach. The use of the endoscope in the CPA as a tool to increase the extent of resection, minimize complications, and preserve the function of the delicate CPA structures