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Erschienen in:
01.04.2015 | How I Do it - Spine - Neurosurgical Techniques
Fully endoscopic retrosigmoid approach for posterior petrous meningioma and trigeminal microvascular decompression
Erschienen in: Acta Neurochirurgica | Ausgabe 4/2015
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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.