ABSTRACT:
Objective:
To perform a risk assessment of endoscope-assisted microsurgery via transcranial approaches for different skull base lesions.
Methods:
We evaluated 70 patients who underwent endoscope-assisted surgery for various pathologies of the skull base via transcranial approaches from February 2010 till Mach 2015 at the Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany. Retrospectively we analyzed the patient charts, operating reports, pre- and postoperative imaging, intraoperative video recordings, ICU charts and follow-up data.
We focused in particular on morbidity and mortality due to the endoscopic procedure.
All surgeries were performed combining microscope (Pentero OPMI, Karl Zeiss, Oberkochen) and rigid endoscope (0°, 30°, 45° optics, Karl Storz, Tuttlingen). The angled optics were introduced under direct microscopic control. Continuous intraoperative neuromonitoring is standard in our Department for procedures in the posterior fossa.
Results:
Mean age at surgery was 45 years (SD ± 14.8) (range 9-83y); 62% were male and 38% female with the male-to- female ratio was 1.12:1 .The pathologies treated were: Vestibular Schwannoma (38), Epidermoid cyst (17), Posterior circulation aneurysms (6) , Trigeminal ganglion lesion (2 Patient) and Anterior circulation aneurysms (9).
These cases had been managed by the following approaches: lateral suboccipital retrosegmoid (59 cases) and pterional (11 cases)
Complications were in the form of; 17 cases of cranial nerve injury: 1 case of trochlear paralysis, 16 cases of facial palsy. All deficits were temporary post-operative and recovered in the follow-up. Except the trochlear nerve injury and one case of facial palsy which needed sural graft.
Further occurred 1 case of postoperative infection, 4 cases of CSF fistula, 1 postoperative bleeding, 1 pneumocephalus, 1 cases of vascular insult (PICA insult).
The mortality rate was zero.
Regarding the use of the endoscope, no thermal CN injury occurred. In one case the trochlear nerve was injured mechanically due to the endoscope.
Conclusion: The endoscope was a helpful tool allowing exploration of the hidden areas of skull base minimizing drilling and retraction of neurovascular and brain structures. Using the endoscope as an assisting tool to the microscope enables a safer surgery for the different skull base lesions even with lesions not visible in a straight line with microscopic view. The risks due to insertion of the endoscope under microscopic guidance are low. The time of procedure is short. We expect that new advancement in the endoscopic instrument will enable more improvement in the endoscopic assisted surgery..
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