Fully endoscopic retrosigmoid approach for posterior petrous meningioma and trigeminal microvascular decompression.

Abstract

BACKGROUND:

Cerebellopontine angle tumor resection and cranial nerve microvascular decompression are usually performed with the aid of the surgical microscope. The endoscope is commonly used as an adjuvant.

METHOD:

A retrosigmoid craniectomy is done. Upon dural opening, the endoscope is inserted into the operative field along the petrotentorial junction. Cerebrospinal fluid drainage provides a wider space for introduction of the endoscope and surgical instruments. Traditional microsurgical techniques are used during the entire procedure.

CONCLUSION:

A fully endoscopic retrosigmoid approach is a safe and effective procedure for cerebellopontine angle tumor resection and cranial nerve microvascular decompression.

KEY POINTS:

• Careful examination of preoperative studies is needed to identify anatomical peculiarities. • Patient positioning: the head must be gently flexed and its vertex gently tilted toward the floor. • Neurophysiologic monitoring and intraoperative navigation. • Craniectomy: partial exposure of the transverse and sigmoid sinuses. • Curvilinear dural incision reflected laterally to minimize the risk of sinus injury. • Opening the cerebellomedullary cistern for CSF drainage and cerebellar relaxation. • Dynamic endoscopy enhances depth perception and must be performed by a team with experience in endoscopic intracranial surgery. • Traditional microsurgical techniques have to be applied during the entire operation. • Multilayer reconstruction, including watertight dural closure. • Meningiomas causing brainstem shift are not suitable for endoscopic resection.

• Authors: Francisco Vaz-Guimaraes, Paul A Gardner, Juan C Fernandez-Miranda
• Journal: Acta neurochirurgica (Acta Neurochir (Wien)) Vol. 157 Issue 4 Pg. 611-5; discussion 615 (Apr 2015) ISSN: 0942-0940 [Electronic] Austria
• PMID: 25596641 (Publication Type: Journal Article)

Topics

• Cerebellopontine Angle (surgery)
• Humans
• Meningeal Neoplasms (surgery)
• Meningioma (surgery)
• Microvascular Decompression Surgery (methods)
• Neuroendoscopy (methods)
• Trigeminal Nerve (surgery)