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Blue R, Yang AI, Ajmera S, Spadola M, Howard S, Saylany A, Kvint S, Harber A, Daly M, Shekhtman E, Nair A, Deshpande R, Lee JY. Pain Outcomes Following Endoscopic Microvascular Decompression for Trigeminal Neuralgia Based on Vascular Compression Type. J Neurol Surg B Skull Base 2024; 85:287-294. [PMID: 38721365 PMCID: PMC11076079 DOI: 10.1055/a-2065-9650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Background Arterial compression of the trigeminal nerve at the root entry zone has been the long-attributed cause of compressive trigeminal neuralgia despite numerous studies reporting distal and/or venous compression. The impact of compression type on patient outcomes has not been fully elucidated. Objective We categorized vascular compression (VC) based on vessel and location of compression to correlate pain outcomes based on compression type. Methods A retrospective video review of 217 patients undergoing endoscopic microvascular decompression for trigeminal neuralgia categorizing VC into five distinct types, proximal arterial compression (VC1), proximal venous compression (VC2), distal arterial compression (VC3), distal venous compression (VC4), and no VC (VC5). VC type was correlated with postoperative pain outcomes at 1 month ( n = 179) and last follow-up (mean = 42.9 mo, n = 134). Results At 1 month and longest follow-up, respectively, pain was rated as "much improved" or "very much improved" in 89 69% of patients with VC1, 86.6 and 62.5% of patients with VC2, 100 and 87.5% of patients with VC3, 83 and 62.5% of patients with VC4, and 100 and 100% of patients with VC5. Multivariate analysis demonstrated VC4 as a significant negative of predictor pain outcomes at 1 month, but not longest follow-up, and advanced age as a significant positive predictor. Conclusion The degree of clinical improvement in all types of VC was excellent, but at longest follow-up VC type was not a significant predictor out outcome. However distal venous compression was significantly associated with worse outcomes at 1 month.
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Affiliation(s)
- Rachel Blue
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Andrew I. Yang
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sonia Ajmera
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michael Spadola
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Susanna Howard
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Anissa Saylany
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Svetlana Kvint
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alexander Harber
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Megan Daly
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Emily Shekhtman
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Anjana Nair
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Riddhi Deshpande
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - John Y.K. Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Sharafudeen A, Komatsu F, Kabulo KDM, Kato Y. How I do it: endoscopic microvascular decompression for hemifacial spasm associated with anterior inferior cerebellar artery-posterior inferior cerebellar artery common trunk. Acta Neurochir (Wien) 2024; 166:49. [PMID: 38289407 DOI: 10.1007/s00701-024-05963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Multiple vessels from the anterior inferior cerebellar artery-posterior inferior cerebellar artery common trunk (APC) variation of the posterior circulation can cause hemifacial spasm (HFS). METHOD Endoscopic microvascular decompression (eMVD) was performed using 0° and 30° endoscopes through a retrosigmoid keyhole. The root exit zone (REZ) was decompressed by transpositioning the offending anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) arising from the APC under excellent endoscopic view. CONCLUSION eMVD is an advanced, minimally invasive and reliable technique to resolve the neurovascular conflict (NVC) in HFS due to offenders from APC.
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Affiliation(s)
- Afsal Sharafudeen
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan.
| | - Fuminari Komatsu
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan
| | | | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Japan
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Saied M, Najibullah M, Shabbir Z, Saleem A, Ali A, Azab WA. Fully Endoscopic Retrosigmoid Approach for Cerebellopontine Angle Tumors. Adv Tech Stand Neurosurg 2024; 52:229-244. [PMID: 39017797 DOI: 10.1007/978-3-031-61925-0_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
BACKGROUND Fully endoscopic or endoscope-controlled approaches are essentially keyhole approaches in which rigid endoscopes are the sole visualization tools used during the whole procedure. At the early attempts of endoscope-assisted cranial surgery, it was noted that rigid endoscopes enabled overcoming the problem of suboptimal visualization when small exposures are used. The technical specifications and design of the currently available rigid endoscopes are associated with a group of unique features that define the endoscopic view and lay the basis for its superiority over the microscopic view during brain surgery. Fully endoscopic retrosigmoid approach for cerebellopontine angle tumors is a minimally invasive approach that is not routinely practiced by neurosurgeons, with few series published so far. Unfamiliarity with the technique, steep learning curve, and concerns about inadequate exposure, neurovascular injury, and decreased visibility may explain this fact. In this chapter we elaborate on the surgical technique and nuances of the fully endoscopic retrosigmoid approach and present an overview of the published series. METHODS From a prospective database of endoscopic procedures maintained by the senior author, clinical data, imaging studies, operative charts, and videos of cases undergoing fully endoscopic retrosigmoid approach for cerebellopontine angle tumors were retrieved and analyzed. The pertinent literature was also reviewed. RESULTS The surgical technique of the fully endoscopic retrosigmoid approach was formulated. CONCLUSION The endoscopic technique has many advantages over the conventional procedures. In our hands, the technique has proven to be feasible, efficient, and minimally invasive with excellent results.
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Affiliation(s)
- Mohamed Saied
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
- Neurosurgery Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mustafa Najibullah
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Zafdam Shabbir
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Athary Saleem
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
| | - Amjad Ali
- Neurosurgery Department, Ibn Sina Hospital, Al-Sabah Medical Area, Kuwait City, Kuwait
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Kurucz P, Ganslandt O, Buchfelder M, Barany L. Microsurgical anatomy and pathoanatomy of the outer arachnoid membranes in the cerebellopontine angle: cadaveric and intraoperative observations. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05601-x. [PMID: 37133788 DOI: 10.1007/s00701-023-05601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The cerebellopontine angle (CPA) is a frequent region of skull base pathologies and therefore a target for neurosurgical operations. The outer arachnoid is the key structure to approach the here located lesions. The goal of our study was to describe the microsurgical anatomy of the outer arachnoid of the CPA and its pathoanatomy in case of space-occupying lesions. METHODS Our examinations were performed on 35 fresh human cadaveric specimens. Macroscopic dissections and microsurgical and endoscopic examinations were performed. Retrospective analysis of the video documentations of 35 CPA operations was performed to describe the pathoanatomical behavior of the outer arachnoid. RESULTS The outer arachnoid cover is loosely attached to the inner surface of the dura of the CPA. At the petrosal surface of the cerebellum the pia mater is strongly adhered to the outer arachnoid. At the level of the dural penetration of the cranial nerves, the outer arachnoid forms sheath-like structures around the nerves. In the midline, the outer arachnoid became detached from the pial surface and forms the base of the posterior fossa cisterns. In pathological cases, the outer arachnoid became displaced. The way of displacement depends on the origin of the lesion. The most characteristic patterns of changes of the outer arachnoid were described in case of meningiomas, vestibular schwannomas, and epidermoid cysts of the CPA. CONCLUSION The knowledge of the anatomy of the outer arachnoid of the cerebellopontine region is essential to safely perform microsurgical approaches as well as of dissections during resection of pathological lesions.
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Affiliation(s)
- Peter Kurucz
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany.
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany
| | - Laszlo Barany
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanalage 60, 91054, Erlangen, Germany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Jiang H, Zou D, Wang P, Zeng L, Liu J, Tang C, Zhang G, Tan X, Wu N. Case report: Fully endoscopic microvascular decompression for trigeminal neuralgia. Front Neurol 2023; 13:1090478. [PMID: 36712457 PMCID: PMC9875060 DOI: 10.3389/fneur.2022.1090478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Microvascular decompression is safe, effective, and micro-invasive. Due to these advantages, it has become the mainstream treatment for trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm. Initially, microvascular decompression was performed under a microscope, which limited the light source and visualization capabilities. With the development of endoscopic technology, the endoscope has been used in microvascular decompression, which further improved the visualization range and light source properties. The purpose of the present study was to investigate the efficacy of fully endoscopic microvascular decompression for the treatment of trigeminal neuralgia. In total, three patients with trigeminal neuralgia who underwent fully endoscopic microvascular decompression were evaluated. After surgery, the facial pain of all patients was significantly relieved. In addition, there were no obvious postoperative complications and no recurrence after 6 months of follow-up. These excellent surgical outcomes indicate that fully endoscopic microvascular decompression is an effective and safe method for the treatment of trigeminal neuralgia. Furthermore, it also shows that the endoscope presents advantages for use in microvascular decompression.
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Affiliation(s)
- Haotian Jiang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Dewei Zou
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Longwei Zeng
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Jie Liu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Chao Tang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Gang Zhang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Xiaorong Tan
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
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Rath TJ, Policeni B, Juliano AF, Agarwal M, Block AM, Burns J, Conley DB, Crowley RW, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Jain V, Powers WJ, Rosenow JM, Taheri MR, DuChene Thoma K, Zander D, Corey AS. ACR Appropriateness Criteria® Cranial Neuropathy: 2022 Update. J Am Coll Radiol 2022; 19:S266-S303. [PMID: 36436957 DOI: 10.1016/j.jacr.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Cranial neuropathy can result from pathology affecting the nerve fibers at any point and requires imaging of the entire course of the nerve from its nucleus to the end organ in order to identify a cause. MRI with and without intravenous contrast is often the modality of choice with CT playing a complementary role. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Tanya J Rath
- Division Chair of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Bruno Policeni
- Panel Chair; Department of Radiology Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa; President Iowa Radiological Society and ACR Councilor
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; NI-RADS committee chair
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin; Fellowship Program Director
| | - Alec M Block
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Judah Burns
- Montefiore Medical Center, Bronx, New York; Vice-Chair for Education & Residency Program Director, Montefiore Medical Center; Vice-Chair, Subcommittee on Methodology
| | - David B Conley
- Practice Director, Northwestern ENT and Rhinology Fellowship Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Member, American Academy of Otolaryngology-Head and Neck Surgery
| | - R Webster Crowley
- Rush University Medical Center, Chicago, Illinois; Neurosurgery expert; Chief, Cerebrovascular and Endovascular Neurosurgery; Medical Director, Department of Neurosurgery; Surgical Director, Rush Comprehensive Stroke Center; Program Director, Endovascular Neurosurgery
| | | | - Elliott R Friedman
- University of Texas Health Science Center, Houston, Texas; Diagnostic Radiology Residency Program Director
| | - Maria K Gule-Monroe
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Medical Director of Diagnostic Imaging at Houston Area Location Woodlands
| | - Mari Hagiwara
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, New York University Langone Medical Center, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio; Medical Director, Lumina Imaging
| | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Joshua M Rosenow
- Neuroradiology Fellowship Program Director and Head and Neck Imaging Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia; Director of Neuroradiology
| | - Kate DuChene Thoma
- Director of Faculty Development Fellowship, University of Iowa Hospital, Iowa City, Iowa; Primary care physician
| | - David Zander
- Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Combined endoscopic and exoscopic resection of intracranial epidermoid cysts. World Neurosurg 2022; 168:e28-e33. [PMID: 36055616 DOI: 10.1016/j.wneu.2022.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This article aims at introducing an endoscopic-exoscopic technique for the resection of epidermoid cysts. METHODS We retrospectively analyzed the intracranial epidermoid cysts patients who received whole course combined endoscopic and exoscopic resection between 2017 and 2020 at our institution, to explore the benefit of combined endoscopic and exoscopic resection of intracranial epidermoid cysts and evaluated the clinical utility of endoscopic-exoscopic technique. RESULTS A total of 17 patients were enrolled in the study. Of all patients, 6 patients (6/17, 35.3%) underwent total resection, 10 patients (10/17, 58.8%) underwent subtotal resection (residual capsule and/or) and 1 patient (1/17, 5.9%) underwent partial resection. Postoperative surgical complications were seen in 3 patients (3/17, 17.6%), including intracranial infection in 2 patients (2/17, 11.8%) , and a delayed postoperative hematoma observed in the seventh day after operation for 1 patient (1/17, 5.9%), who was treated in a conservative manner and recovered smoothly from the hemorrhage. The median follow-up time was 33.3 months (range 14.5-54.5 months). During the follow-up period, there was no recurrence of the tumors that received total resection. 2 patients developed residual tumor regrowth but did not show any symptom therefore no further surgery was required. CONCLUSIONS Endoscopic-exoscopic technique is safe and efficient in the resection of intracranial epidermoid cysts with panoramic views and superior maneuverability. With further development and accumulation of practical experiences, the endoscopic-exoscopic technique can also be applied in the resection of other intracranial tumors.
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Zhou J, Shi Q, Jiang L, Xie Y, Deng B, Zhan Y. Association study of the pneumatization degree of mastoid air cells and postoperative complications after microvascular decompression in hemifacial spasm. Acta Neurochir (Wien) 2022; 164:1543-1550. [PMID: 35190898 DOI: 10.1007/s00701-022-05155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to analyse the association between the degree of pneumatization of mastoid air cells (MACs) and postoperative complications after microvascular decompression in hemifacial spasm. METHODS We retrospectively reviewed 308 patients with hemifacial spasm who underwent surgery at our institute between January 2017 and March 2021. The degree of pneumatization of MACs was classified into four grades (grades 1, 2, 3, and 4) according to method of Han et al. The clinical data of the four grades were analysed and statistically examined. RESULTS There were no statistically significant differences between the four grades in terms of the operative time, intraoperative blood loss, and postoperative hospital stay (all, P > 0.05). The incidence of hearing loss was higher in grade 4 MACs (26.56%) than in grades 1 and 2 MACs (5.41% and 2.89%, respectively; P < 0.05). The incidence of facial paralysis was higher in grade 4 MACs (28.13%) than in grades 1 and 2 MACs (5.41% and 9.18%, respectively; P < 0.001). The incidence of intracranial infection was higher in grade 3 MACs (17.65%) than in grade 2 MACs (3.89%) (P < 0.05). All four patients with cerebrospinal fluid leakage belonged to grade 4 MACs. The incidence of cerebrospinal fluid leakage was higher in grade 4 MACs (5.13%) than in grade 2 MACs (P < 0.05). CONCLUSIONS This study found that the degree of pneumatization of MACs was closely related to the postoperative complications after MVD surgeries. Well-pneumatized MACs increase the risk of cerebrospinal fluid leakage and intracranial infection. However, insufficient exposure increases the risk of facial paralysis and hearing loss. For patients with well-pneumatized MACs, sufficient surgical exposure is the top priority when locating the bone hole. For those who may have a latent MAC opening, preventive occlusion should be considered.
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Affiliation(s)
- Jianxin Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Quanhong Shi
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Li Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yanfeng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bo Deng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yan Zhan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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9
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Komatsu F, Sasaki K, Tanaka R, Miyatani K, Yamada Y, Kato Y, Hirose Y. Virtual surgical analysis of endoscopic microvascular decompression for hemifacial spasm. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Fouda MA, Jeelani Y, Gokoglu A, Iyer RR, Cohen AR. Endoscope-assisted microsurgical retrosigmoid approach to the lateral posterior fossa: Cadaveric model and a review of literature. Surg Neurol Int 2021; 12:416. [PMID: 34513180 PMCID: PMC8422411 DOI: 10.25259/sni_157_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/20/2021] [Indexed: 11/09/2022] Open
Abstract
Background: The advancement of endoscopic techniques in the past decade has improved the surgical management of cerebellopontine angle (CPA) tumors. Endoscope-assisted microsurgery improves the ability to evaluate the extent of resection, achieve safe tumor resection and reduce the risk of surgery-related morbidity. Methods: In this study, we used a cadaveric model to demonstrate a step by step endoscope-assisted microsurgery of the retrosigmoid approach to the lateral posterior fossa. Results: Retrosigmoid craniotomies were performed on four latex-injected cadaver heads (eight CPAs). Microsurgical exposures were performed to identify neurovascular structures in each segment. 0° and 30° rigid endoscope lenses were subsequently introduced into each corridor and views were compared in this manner. The endoscopic images were compared with the standard microscopic views to determine the degree of visualization with each technique. In each case, better visualization was provided by both the 0° and 30° endoscope lenses. Endoscopic views frequently clarified neurovascular relationships in obscured anatomic regions. Conclusion: Endoscope-assisted microsurgery could allow better visualization of various regions of the posterior fossa. Surgical planning for posterior fossa lesions should include consideration of this combined approach.
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Affiliation(s)
- Mohammed A Fouda
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yasser Jeelani
- Department of Neurosurgery, Brigham and Woman's Hospital, Boston, Massachusetts.,Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Abdulkarim Gokoglu
- Department of Neurosurgery, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Rajiv R Iyer
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan R Cohen
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Fully endoscopic versus microscopic vascular decompression for hemifacial spasm: a retrospective cohort study. Acta Neurochir (Wien) 2021; 163:2417-2423. [PMID: 33765219 DOI: 10.1007/s00701-021-04824-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Microvascular decompression (MVD) is the preferred surgical method for hemifacial spasm (HFS). The purpose of this study was to analyze the effectiveness and safety of fully endoscopic MVD for HFS relative to microscopic MVD. MATERIAL AND METHODS The retrospective study was conducted on HFS patients who underwent microscopic or fully endoscopic MVD from January 2018 to March 2019. All patients were treated at a single institution and by a single surgeon. Patients were divided into two groups based on the surgical method, and clinical data were then compared between groups. RESULTS A total of 116 patients, including 54 cases who received fully endoscopic MVD (E group) and 62 cases who received microscopic MVD (M group), were included in this study. Follow-up efficacy did not differ significantly between groups, with total effective rates of 88.9% in the E group and 90.3% in the M group. When postoperative complications were compared individually, there were no statistically significant differences between the two groups; however, the E group had a higher total incidence of complications than the M group (48.1% vs. 29.0%, P = 0.034). CONCLUSION Although both fully endoscopic and microscopic MVD for HFS achieved good efficacy, the former method had a higher total incidence of complications. Based on the results of this study, there is no evidence that a microscope can be replaced by a full endoscope in MVD for HFS.
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Gopakumar S, Srinivasan VM, Sharma H, Cherian J, Patel AJ. Fully Endoscopic Resection of an Epidermoid Cyst of the Cerebellopontine Angle: Bilateral Resection via a Unilateral Approach. Oper Neurosurg (Hagerstown) 2021; 20:E152-E155. [PMID: 32970119 DOI: 10.1093/ons/opaa291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/05/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Epidermoid cysts are rare, benign intracranial neoplasms that typically arise at the cerebellopontine angle (CPA) and can be extensive lesions that intricately involve many critical neurovascular structures. We describe the case of a patient who presents with the classic picture of CPA epidermoid cyst and describe the value of the 4K endoscope for resection, which is illustrated in our accompanying surgical video. CLINICAL PRESENTATION The patient presents with headache, nausea, and vomiting accompanied by dizziness and balance issues. Radiographic imaging demonstrated a large lesion highly consistent with epidermoid cyst which involved the left CPA, encircled the basilar artery, and extended to the opposite side. Surgery was planned with a small left-sided retrosigmoid craniotomy with use of a 2-dimensional 4K endoscope to aid in resection, particularly of the contralateral side. This approach was successful with gross total resection apparent at 14-mo follow-up. CONCLUSION We describe the use of a fully endoscopic technique from a unilateral approach for resection of a lesion that extended in the CPA bilaterally. Additionally, we highlight the relevant neuroanatomical and neurovascular structures in this highly critical intracranial region which is well-visualized through endoscopy in the associated surgical video.
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Affiliation(s)
| | | | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, Texas
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Komatsu F, Kishore K, Sengupta R. How I do it: endoscopic microvascular decompression for glossopharyngeal neuralgia. Acta Neurochir (Wien) 2020; 162:2833-2835. [PMID: 32556527 DOI: 10.1007/s00701-020-04456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) is associated with high complication and incomplete cure rates because of its poor ability to visualize neurovascular conflicts. METHOD Fully endoscopic MVD for GPN was carried out through a retrosigmoid keyhole approach. Neurovascular conflicts were clearly demonstrated with a loop of the posterior inferior cerebellar artery (PICA) under a 30° endoscopic view, and no significant cerebellar retraction was observed. The loop of the PICA was safely decompressed and the perforators were preserved while offering an excellent operative view. CONCLUSION Endoscopic MVD is a reliable and minimally invasive method for GPN.
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Affiliation(s)
- Fuminari Komatsu
- Department of Neurosurgery, Institute of Neurosciences Kolkata, 185/1 A. J. C. Bose Road, Kolkata, West Bengal, 700017, India.
| | - Kislay Kishore
- Department of Neurosurgery, Institute of Neurosciences Kolkata, 185/1 A. J. C. Bose Road, Kolkata, West Bengal, 700017, India
| | - Robin Sengupta
- Department of Neurosurgery, Institute of Neurosciences Kolkata, 185/1 A. J. C. Bose Road, Kolkata, West Bengal, 700017, India
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Blue R, Li C, Spadola M, Saylany A, McShane B, Lee JYK. Complication Rates During Endoscopic Microvascular Decompression Surgery Are Low With or Without Petrosal Vein Sacrifice. World Neurosurg 2020; 138:e420-e425. [PMID: 32145425 DOI: 10.1016/j.wneu.2020.02.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Endoscopic-microvascular decompression (E-MVD) is a well-described treatment for trigeminal neuralgia (TGN), but there has been debate on the safety of intraoperative sacrifice of the petrosal vein (PV) due to concern for subsequent venous insufficiency. Our objective was to investigate the risk of PV sacrifice during E-MVD in TGN and subsequent postoperative complications and pain outcomes. METHODS 5 five-year review yielded 201 patients who underwent MVD for TGN. PV sacrifice, vascular compressive anatomy, and postoperative complications attributable to venous insufficiency were analyzed. Preoperative and postoperative pain outcomes were analyzed. RESULTS PV was sacrificed in 118 of 201 (59%) of patients, with 43 of 201 (21%) patients undergoing partial sacrifice versus 75 of 201 (37%) with complete sacrifice. No cases of venous infarction, cerebellar swelling, or fatal complications were noted in either cohort. Non-neurologic complications occurred in 1.69% (2 of 118) of patients with PV sacrifice and 0% (0 of 83) of patients with PV preservation. Neurologic deficits (facial palsy, conductive hearing loss, gait instability, memory deficit) occurred in equal proportions in PV preservation and sacrifice groups (2.41% vs. 1.69%) Overall, 87.3% (145 of 166) patients reported their pain as "very much improved" or "much improved" at 1 month, and no difference between groups was identified. CONCLUSIONS This study did not find higher complication rates in patients undergoing petrosal vein sacrifice during E-MVD for trigeminal neuralgia. In this series where petrosal vein was sacrificed only 59% of the time, it appears to be a safe technique, but larger studies will be needed to determine true incidence of complications after PV sacrifice.
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Affiliation(s)
- Rachel Blue
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Carrie Li
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Spadola
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anissa Saylany
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan McShane
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Corrivetti F, Cacciotti G, Scavo CG, Roperto R, Stati G, Sufianov A, Mastronardi L. Flexible endoscopic assistance in the surgical management of vestibular schwannomas. Neurosurg Rev 2019; 44:363-371. [PMID: 31768695 DOI: 10.1007/s10143-019-01195-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/13/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022]
Abstract
Endoscopic-assisted techniques have extensively been applied to vestibular schwannoma (VS) surgery allowing to increase the extent of resection, minimize complications, and preserve facial nerve and auditory functions. In this paper, we retrospectively analyze the effectiveness of flexible endoscope in the endoscopic-assisted retrosigmoid approach for the surgical management of VS of various sizes. The authors conducted a retrospective analysis on 32 patients who underwent combined microscopic and flexible endoscopic resection of VS of various sizes over a period of 16 months. Flexible endoscopic-assisted retrosigmoid approach was performed in all cases, and in 6 cases, flexible and rigid endoscopic control were used in combination to evaluate the differences between the two surgical instruments. The surgical results were additionally compared with a previous case series of 141 patients operated for VS of various sizes without endoscopic assistance. Gross-total resection was achieved in 84% of the cases and near-total resection was accomplished in the rest of them. Excellent or good facial nerve function was observed in all except one case with a preoperative severe facial palsy. Hearing preservation surgery (HPS) was attempted in 11 cases and accomplished in 9 (81.8%). A tumor remnant was endoscopically identified in the fundus of the IAC in all cases (100%). Endoscopic assistance increased the rate of total removal and no intrameatal residual tumor was seen at radiological follow-up. Comparative analysis with a surgical cohort of patients operated with the sole microsurgical technique showed a significative association between endoscopic assistance and intracanalicular extent of resection. Combined microsurgical and flexible endoscopic assistance provides remarkable advantages in the pursuit of maximal safe resection of VS and preservation of facial nerve and auditory functions, minimizing the risk of post-operative complications.
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Affiliation(s)
- Francesco Corrivetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL, 1, Roma, Roma, Italy
| | - Guglielmo Cacciotti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL, 1, Roma, Roma, Italy
| | - Carlo Giacobbo Scavo
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL, 1, Roma, Roma, Italy
| | - Raffaelino Roperto
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL, 1, Roma, Roma, Italy
| | - Giovanni Stati
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL, 1, Roma, Roma, Italy
| | - Albert Sufianov
- Federal Centre of Neurosurgery, Tyumen, Russian Federation.,Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Moscow, Russian Federation
| | - Luciano Mastronardi
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL, 1, Roma, Roma, Italy. .,Department of Neurosurgery, The State Education Institution of Higher Professional Training, The First Sechenov Moscow State Medical University under Ministry of Health, Moscow, Russian Federation.
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16
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Arıcıgil M, Arbağ H, Dündar MA, Aziz SK, Yılmaz MT. Minimally Invasive Endoscopic Retrosigmoid Approach to the Cerebellopontine Angle Using a Novel Surgical Instrument: A Cadaveric Study. J Int Adv Otol 2019; 14:472-477. [PMID: 30644376 DOI: 10.5152/iao.2018.4474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In this study, we aimed to describe how endoscopes show the neural and vascular structures at the cerebellopontine angle (CPA) through a minimal craniotomy in a well-described anatomic point in the retrosigmoid region and at the same time, evaluate the endoscopic anatomic exposure and maneuverability. We planned to use the new surgical instrument (endoscope cannula), which we designed on fresh frozen cadavers to simulate a real surgical procedure. MATERIALS AND METHODS The surgical procedure was planned to be performed on 20 sides of 10 fresh cadaver heads. The distance between the asterion and mastoid process was determined, and the midpoint was then marked. From this midpoint, a craniotomy 2 cm in size was posteriorly made. The endoscope cannula together with 0° or 30° endoscopes was inserted to capture the panoramic views of the neurovascular structures in CPA. Endoscopic anatomic exposure and maneuverability were evaluated using 0° and 30° endoscopes with/without the endoscope cannula. RESULTS The surgeon could easily use both hands during the surgical simulation, and maneuverability was seen to increase in CPA with the use of the endoscope cannula. CONCLUSION The surgeon can work actively with both hands when the endoscopes and the endoscope cannula are used together. We believe that owing to this, the surgeon's maneuverability would increase and a more effective minimally invasive endoscopic retrosigmoid surgery would ensue.
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Affiliation(s)
- Mitat Arıcıgil
- Department of Otorhinolaryngology, Head and Neck Surgery, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Hamdi Arbağ
- Department of Otorhinolaryngology, Head and Neck Surgery, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mehmet Akif Dündar
- Department of Otorhinolaryngology, Head and Neck Surgery, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Suhayb Kuria Aziz
- Department of Otorhinolaryngology, Head and Neck Surgery, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mehmet Tuğrul Yılmaz
- Department of Anatomy, Necmettin Erbakan University School of Medicine, Konya, Turkey
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Matsushima T, Matsushima K, Kobayashi S, Lister JR, Morcos JJ. The microneurosurgical anatomy legacy of Albert L. Rhoton Jr., MD: an analysis of transition and evolution over 50 years. J Neurosurg 2018; 129:1331-1341. [PMID: 29393756 DOI: 10.3171/2017.7.jns17517] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/13/2017] [Indexed: 11/06/2022]
Abstract
The authors chronologically categorized the 160 original articles written by Dr. Rhoton and his fellows to show why they selected their themes and how they carried out their projects. The authors note that as neurosurgery progresses and new techniques and approaches are developed, accurate and safe treatment will depend upon continued clarification of microsurgical anatomy.
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Affiliation(s)
- Toshio Matsushima
- 1International University of Health and Welfare
- 2Neuroscience Center, Fukuoka Sanno Hospital, Fukuoka
| | - Ken Matsushima
- 3Department of Neurosurgery, Tokyo Medical University, Tokyo
| | - Shigeaki Kobayashi
- 4Medical Research and Education Center, Aizawa Hospital, Matsumoto, Japan
| | - J Richard Lister
- 5Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Jacques J Morcos
- 6Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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18
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Corrivetti F, Cacciotti G, Giacobbo Scavo C, Roperto R, Mastronardi L. Flexible Endoscopic-Assisted Microsurgical Radical Resection of Intracanalicular Vestibular Schwannomas by a Retrosigmoid Approach: Operative Technique. World Neurosurg 2018; 115:229-233. [PMID: 29704694 DOI: 10.1016/j.wneu.2018.04.108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Abstract
The efficacy of endoscopic techniques in the surgical management of intracanalicular vestibular schwannomas (ICVSs) has been underlined in recent studies. An endoscopic- assisted retrosigmoid approach (EARSA) appears to be particularly suitable for achieving complete resection of an ICVS. In this study, we describe the surgical treatment of 3 cases of ICVS with an EARSA, highlighting the advantages and limitations of flexible endoscopy in accomplishing a safe radical resection with hearing preservation. Three patients with an ICVS underwent surgery via a flexible endoscopic-assisted microneurosurgical retrosigmoid approach. Flexible endoscopic assistance allowed the identification of residual tumor located in the most lateral portion of the fundus of the internal auditory canal in all cases. Endoscopic controls and further microsurgical resection were attempted, and complete surgical resection was achieved in all cases without the occurrence of postoperative facial or auditory nerve dysfunction. Flexible endoscopy appears to be particularly useful and safe in the surgical management of ICVS by microneurosurgery via an EARSA.
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Affiliation(s)
- Francesco Corrivetti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy
| | - Guglielmo Cacciotti
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy
| | - Carlo Giacobbo Scavo
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy
| | - Raffaelino Roperto
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy
| | - Luciano Mastronardi
- Division of Neurosurgery, Department of Surgical Specialties, San Filippo Neri Hospital/ASL Roma 1, Rome, Italy.
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19
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Komatsu F, Imai M, Matsumae M. How I do it: endoscopic microvascular decompression for hemifacial spasm associated with the vertebral artery. Acta Neurochir (Wien) 2018; 160:157-159. [PMID: 29143107 DOI: 10.1007/s00701-017-3392-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microvascular decompression (MVD) of hemifacial spasm (HFS) associated with the vertebral artery (VA) shows higher rates of incomplete cure and complications compared to non-VA-related HFS. METHOD Purely endoscopic MVD for VA-associated HFS via a retrosigmoid keyhole was performed. Neurovascular conflicts by a directly offending artery and VA around the root exit zone of the facial nerve were clearly demonstrated under 30° endoscopic view without significant cerebellar retraction. The VA and directly offending artery were safely transposed with preservation of perforators under excellent view. CONCLUSION Endoscopic MVD offers reliable decompression for VA-associated HFS with minimal invasiveness.
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Affiliation(s)
- Fuminari Komatsu
- Department of Neurosurgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan.
| | - Masaaki Imai
- Department of Neurosurgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan
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20
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Akiyama O, Matsushima K, Gungor A, Matsuo S, Goodrich DJ, Shane Tubbs R, Klimo P, Cohen-Gadol AA, Arai H, Rhoton AL. Microsurgical and endoscopic approaches to the pulvinar. J Neurosurg 2017; 127:630-645. [DOI: 10.3171/2016.8.jns16676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEApproaches to the pulvinar remain challenging because of the depth of the target, surrounding critical neural structures, and complicated arterial and venous relationships. The purpose of this study was to compare the surgical approaches to different parts of the pulvinar and to examine the efficacy of the endoscope as an adjunct to the operating microscope in this area.METHODSThe pulvinar was examined in 6 formalin-fixed human cadaveric heads through 5 approaches: 4 above and 1 below the tentorium. Each approach was performed using both the surgical microscope and 0° or 45° rigid endoscopes.RESULTSThe pulvinar has a lateral ventricular and a medial cisternal surface that are separated by the fornix and the choroidal fissure, which wrap around the posterior surface of the pulvinar. The medial cisternal part of the pulvinar can be further divided into upper and lower parts. The superior parietal lobule approach is suitable for lesions in the upper ventricular and cisternal parts. Interhemispheric precuneus and posterior transcallosal approaches are suitable for lesions in the part of the pulvinar forming the anterior wall of the atrium and adjacent cisternal part. The posterior interhemispheric transtentorial approach is suitable for lesions in the lower cisternal part and the supracerebellar infratentorial approach is suitable for lesions in the inferior and medial cisternal parts.The microscope provided satisfactory views of the ventricular and cisternal surfaces of the pulvinar and adjacent neural and vascular structures. The endoscope provided multi-angled and wider views of the pulvinar and adjacent structures.CONCLUSIONSA combination of endoscopic and microsurgical techniques allows optimal exposure of the pulvinar.
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Affiliation(s)
- Osamu Akiyama
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
- 2Department of Neurosurgery, Juntendo University, Tokyo
| | - Ken Matsushima
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
- 3Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Abuzer Gungor
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
- 4Department of Neurosurgery, Bakirkoy Research and Training Hospital for Neurology, Neurosurgery, and Psychiatry, Istanbul, Turkey
| | - Satoshi Matsuo
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
- 5Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dylan J. Goodrich
- 6Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - R. Shane Tubbs
- 6Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- 7Seattle Science Foundation, Seattle, Washington
| | - Paul Klimo
- 8Semmes-Murphey Neurologic & Spine Institute and Le Bonheur Children's Hospital, Memphis, Tennessee; and
| | - Aaron A. Cohen-Gadol
- 9Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hajime Arai
- 2Department of Neurosurgery, Juntendo University, Tokyo
| | - Albert L. Rhoton
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
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21
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Kurucz P, Baksa G, Patonay L, Thaher F, Buchfelder M, Ganslandt O. Endoscopic approach-routes in the posterior fossa cisterns through the retrosigmoid keyhole craniotomy: an anatomical study. Neurosurg Rev 2016; 40:427-448. [DOI: 10.1007/s10143-016-0800-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/03/2016] [Indexed: 11/30/2022]
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22
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Komune N, Matsuo S, Miki K, Rhoton AL. The endoscopic anatomy of the middle ear approach to the fundus of the internal acoustic canal. J Neurosurg 2016; 126:1974-1983. [PMID: 27588594 DOI: 10.3171/2016.5.jns16261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The application of the endoscope in the lateral skull base increases the importance of the middle ear cavity as the corridor to the skull base. The aim of this study was to define the middle ear as a route to the fundus (lateral end) of the internal acoustic canal and to propose feasible landmarks to the fundus. METHODS This was a cadaveric study; 34 adult cadaveric temporal bones and 2 dry bones were dissected with the aid of the endoscope and microscope to show the anatomy of the transcanal approach to the middle ear and fundus of the internal acoustic canal. RESULTS In the middle ear cavity, the cochleariform process is one of the key landmarks for accessing the fundus of the internal acoustic canal. The triangle formed by the anterior and posterior edges of the overhang of the round window and the cochleariform process provides a landmark to start drilling the bone to access the fundus of the internal acoustic canal. CONCLUSIONS The external acoustic canal and middle ear cavity combined, using endoscopic guidance, can provide a route to the fundus of the internal acoustic canal. A triangular landmark crossing the promontory has been described for reaching the meatal fundus. This transcanal approach requires an understanding of the relationship between the middle ear cavity and the fundus of the internal acoustic canal and provides a potential new area of cooperation between otology and neurosurgery for accessing pathology in this and the bordering skull base.
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Affiliation(s)
- Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Satoshi Matsuo
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida; and
| | - Koichi Miki
- Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka University, Fukuoka, Japan
| | - Albert L Rhoton
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida; and
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24
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Hong CS, Prevedello DM, Elder JB. Comparison of endoscope- versus microscope-assisted resection of deep-seated intracranial lesions using a minimally invasive port retractor system. J Neurosurg 2016; 124:799-810. [DOI: 10.3171/2015.1.jns141113] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Tubular brain retractors may improve access to deep-seated brain lesions while potentially reducing the risks of collateral neurological injury associated with standard microsurgical approaches. Here, microscope-assisted resection of lesions using tubular retractors is assessed to determine if it is superior to endoscope-assisted surgery due to the technological advancements associated with modern tubular ports and surgical microscopes.
METHODS
Following institutional approval of the tubular port, data obtained from the initial 20 patients to undergo transportal resection of deep-seated brain lesions were analyzed in this study. The pathological entities of the resected tissues included metastatic tumors (8 patients), glioma (7), meningioma (1), neurocytoma (1), radiation necrosis (1), primitive neuroectodermal tumor (1), and hemangioblastoma (1). Surgery incorporated endoscopic (5 patients) or microscopic (15) assistance. The locations included the basal ganglia (11 patients), cerebellum (4), frontal lobe (2), temporal lobe (2), and parietal lobe (1). Cases were reviewed for neurological outcomes, extent of resection (EOR), and complications. Technical data for the port, surgical microscope, and endoscope were analyzed.
RESULTS
EOR was considered total in 14 (70%), near total (> 95%) in 4 (20%), and subtotal (< 90%) in 2 (10%) of 20 patients. Incomplete resection was associated with the basal ganglia location (p < 0.05) and use of the endoscope (p < 0.002). Four of 5 (80%) endoscope-assisted cases were near-total (2) or subtotal (2) resection. Histopathological diagnosis, presenting neurological symptoms, and demographics were not associated with EOR. Complication rates were low and similar between groups.
CONCLUSIONS
Initial experience with tubular retractors favors use of the microscope rather than the endoscope due to a wider and 3D field of view. Improved microscope optics and tubular retractor design allows for binocular vision with improved lighting for the resection of deep-seated brain lesions.
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Setty P, Babu S, LaRouere MJ, Pieper DR. Fully Endoscopic Retrosigmoid Vestibular Nerve Section for Refractory Meniere Disease. J Neurol Surg B Skull Base 2016; 77:341-9. [PMID: 27441160 DOI: 10.1055/s-0035-1570348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE This study aims to report our results and technical details of fully endoscopic retrosigmoid vestibular nerve section. DESIGN A prospective observational study was conducted. SETTING A single academic, tertiary institution involving neurosurgery and neurotology. PARTICIPANTS Previously diagnosed patients with Meniere disease, refractory to medical therapy, who underwent fully endoscopic vestibular nerve section. MAIN OUTCOME MEASURES Postoperative improvement in vertiginous symptoms as well as hearing preservation, based on the American Association of Otolaryngology-Head and Neck Surgeons score and the Gardener and Robertson-Modified Hearing Classification. Facial nerve preservation based on the House-Brackman (HB) score. RESULTS Symptoms improved or resolved in 38 of 41 (92.2%) patients with only 1 of 41 (2.4%) reporting worsening symptoms. All 41 patients (100%) had a postoperative HB score of 1/6, demonstrating full facial nerve preservation. Hearing was stable or improved in 34 of 41 (82.9%) patients. Three complications took place for a rate of 7.3%, one cerebrospinal fluid leak, and two wound infections. CONCLUSION The fully endoscopic approach to vestibular nerve sections is a safe and effective technique for the treatment of medically refractory Meniere disease. This technique also utilizes smaller incisions, minimal cranial openings, and no cerebellar retraction with improved visualization of the cerebellopontine angle neurovascular structures.
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Affiliation(s)
- Pradeep Setty
- Section of Neurosurgery, St. John Providence Hospital and Medical Centers, Michigan State University, Novi, Michigan, United States
| | - Seilesh Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, United States
| | - Michael J LaRouere
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, United States
| | - Daniel R Pieper
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
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Abolfotoh M, Bi WL, Hong CK, Almefty KK, Boskovitz A, Dunn IF, Al-Mefty O. The combined microscopic-endoscopic technique for radical resection of cerebellopontine angle tumors. J Neurosurg 2015; 123:1301-11. [DOI: 10.3171/2014.10.jns141465] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The combined microscopic and endoscopic technique has shown significant advantages in the management of various lesions through different approaches. Endoscopic-assisted techniques have frequently been applied to cerebellopontine angle (CPA) surgery in the context of minimally invasive craniotomies. In this paper the authors report on 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. They also describe a technique of the simultaneous use of the microscope and endoscope in the CPA and dissection of CPA tumors under tandem endoscopic and microscopic vision to overcome the shortcomings of introducing the endoscope alone in the CPA. The reliability of using the microscope alone in dissecting CPA tumors is evaluated, as is the effectiveness of the combined technique in increasing the resectability of various types of CPA tumors.
METHODS
The authors conducted a retrospective analysis of 50 patients who underwent combined microscopic-endoscopic resection of CPA tumors by the senior author over a period of 3 years (February 2011 to February 2014) at Brigham and Women's Hospital, Harvard Medical School. The reliability of the extent of microscopic removal was evaluated with endoscopic exploration. Additional resection was performed with both microscopic and the combined microscopic-endoscopic technique. Endoscopically verified total resection was validated by intraoperative or postoperative MRI. The function of the cranial nerves was evaluated to assess the impact of the combined technique on their function.
RESULTS
A tumor remnant was endoscopically identified in 69% of the 26 patients who were believed to have microscopic total resection. The utilization of the endoscopic visualization and dissection increased endoscopically verified total removal to 38 patients, and 82% of these patients had no sign of residual tumor on postoperative imaging. The technique was most effective with epidermoid tumors. There were a total of 17 new cranial nerve deficits in 10 patients. Preoperative fifth cranial nerve deficits improved in 52% and hearing improved in 29% of patients after surgery.
CONCLUSIONS
This method provides simultaneous microscopic and endoscopic visualization and dissection techniques through skull-base approaches to CPA tumors. It overcomes some of the shortcomings of endoscopic-assisted surgery, further extends the surgical field, and increases the radicality of tumor resection with good functional outcomes.
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Affiliation(s)
- Mohammad Abolfotoh
- 1Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
- 2Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Wenya Linda Bi
- 1Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Chang-Ki Hong
- 1Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
- 3Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea; and
| | - Kaith K. Almefty
- 1Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
- 4Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Abraham Boskovitz
- 1Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ian F. Dunn
- 1Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ossama Al-Mefty
- 1Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
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Komune N, Yagmurlu K, Matsuo S, Miki K, Abe H, Rhoton AL. Auditory brainstem implantation: anatomy and approaches. Neurosurgery 2015; 11 Suppl 2:306-20; discussion 320-1. [PMID: 25793729 DOI: 10.1227/neu.0000000000000736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Auditory brainstem implantation at the cochlear nuclei used mainly for neurofibromatosis type 2 patients with bilateral loss of the cochlear nerves has more recently been extended to the inferior colliculus. OBJECTIVE To examine the microsurgical and endoscopic anatomy of the cochlear nuclei and inferior colliculus as seen through the translabyrinthine and retrosigmoid approaches used for cochlear nuclei and inferior collicular implantation. METHODS Ten cerebellopontine angles of formalin-fixed adult cadaveric heads were examined with the aid of the surgical microscope and endoscope. The ascending auditory pathways between the cochlear nuclei and inferior colliculi and above were examined by the fiber dissection technique. RESULTS Both the translabyrinthine and retrosigmoid routes provide sufficient exposure for concurrent tumor removal and implantation at either the cochlear nuclei or inferior colliculus. The position of the inferior colliculus in the auditory pathways and its accessibility in the infratentorial supracerebellar exposure directed through either the translabyrinthine or retrosigmoid approach makes it an alternative site for electrode placement if the cochlear nuclei are not functionally or structurally suitable for implantation. Endoscopic assistance may aid the exposure and electrode placement at either site. CONCLUSION The translabyrinthine or retrosigmoid approaches provide access to the cochlear nuclei for implantation and also to the inferior colliculus through the translabyrinthine or retrosigmoid infratentorial supracerebellar route. The endoscope may aid in exposing either site.
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Affiliation(s)
- Noritaka Komune
- *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
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Pre-operative image-based segmentation of the cranial nerves and blood vessels in microvascular decompression: Can we prevent unnecessary explorations? Clin Neurol Neurosurg 2015; 139:159-65. [PMID: 26476700 DOI: 10.1016/j.clineuro.2015.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study was conducted to validate the accuracy of image-based pre-operative segmentation using the gold standard endoscopic and microscopic findings for localization and pre-operative diagnosis of the offensive vessel. PATIENTS AND METHODS Fourteen TN and 6 HS cases were randomly selected. All patients had 3T MRI, which included thin-sectioned 3D space T2, 3D Time of Flight and MPRAGE Sequences. Imaging sequences were loaded in BrainLab iPlanNet and fused. Individual segmentation of the affected cranial nerves and the compressing vascular structure was performed by a neurosurgeon, and the results were compared with the microscopic and endoscopic findings by two blinded neurosurgeons. For each case, at least three neurovascular landmarks were targeted. Each segmented neurovascular element was validated by manual placement of the navigation probe over each target, and errors of localization were measured in mm. RESULTS All patients underwent retro-sigmoid craniotomy and MVD using both microscope and endoscope. Based on image segmentation, the compressing vessel was identified in all cases except one, which was also negative intraoperatively. Perfect correspondence was found between image-based segmentation and endoscopic and microscopic images and videos (Dice coefficient of 1). Measurement accuracy was 0.45 ± 0.21 mm (mean ± SD). CONCLUSION Image-based segmentation is a promising method for pre-operative identification and localization of offending blood vessels causing HFS and TN. Using this method may prevent some unnecessary explorations on especially atypical cases with no vascular contacts. However, negative pre-operative image segmentation may not preclude one from exploration in classic cases of TN or HFS. A multicenter study with larger number of cases is recommended.
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Komune N, Matsushima K, Matsushima T, Komune S, Rhoton AL. Surgical approaches to jugular foramen schwannomas: An anatomic study. Head Neck 2015; 38 Suppl 1:E1041-53. [DOI: 10.1002/hed.24156] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 04/10/2015] [Accepted: 05/31/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Noritaka Komune
- Department of Neurosurgery; University of Florida, College of Medicine; Gainesville Florida
- Department of Otorhinolaryngology Head and Neck Surgery; Kyushu University; Fukuoka Japan
| | - Ken Matsushima
- Department of Neurosurgery; University of Florida, College of Medicine; Gainesville Florida
| | | | - Shizuo Komune
- Department of Otorhinolaryngology Head and Neck Surgery; Kyushu University; Fukuoka Japan
| | - Albert L. Rhoton
- Department of Neurosurgery; University of Florida, College of Medicine; Gainesville Florida
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Matsushima T, Kawashima M, Matsushima K, Wanibuchi M. Japanese neurosurgeons and microsurgical anatomy: a historical review. Neurol Med Chir (Tokyo) 2015; 55:276-85. [PMID: 25797782 PMCID: PMC5530048 DOI: 10.2176/nmc.ra.2014-0408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Research in microneurosurgical anatomy has contributed to great advances in neurosurgery in the last 40 years. Many Japanese neurosurgeons have traveled abroad to study microsurgical anatomy and played major roles in advancing and spreading the knowledge of anatomy, overcoming their disadvantage that the cadaver study has been strictly limited inside Japan. In Japan, they initiated an educational system for surgical anatomy that has contributed to the development and standardization of Japanese neurosurgery. For example, the Japanese Society for Microsurgical Anatomy started an annual educational meeting in the middle of 1980s and published its proceedings in Japanese every year for approximately 20 years. These are some of the achievements that bring worldwide credit to Japanese neurosurgeons. Not only should Japanese neurosurgeons improve their educational system but they should also contribute to the international education in this field, particularly in Asia.
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31
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Setty P, D'Andrea KP, Stucken EZ, Babu S, LaRouere MJ, Pieper DR. Endoscopic Resection of Vestibular Schwannomas. J Neurol Surg B Skull Base 2015. [PMID: 26225307 DOI: 10.1055/s-0034-1543974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective To report our results and the technical details of fully endoscopic resection of vestibular schwannomas. Design Prospective observational study. Setting A single academic institution involving neurosurgery and neurotology. Participants Twelve consecutive patients who underwent fully endoscopic resection of a vestibular schwannoma. Main Outcome Measures Hearing preservation, based on the American Association of Otolaryngology-Head and Neck Surgeons (AAO-HNS) score as well as the Gardener and Robertson Modified Hearing Classification (GR). Facial nerve preservation based on the House-Brackmann (HB) score. Results All patients successfully underwent gross total resection. Facial nerve preservation rate was 92% with 11 of 12 patients retaining an HB score of 1/6 postoperatively. Hearing preservation rate was 67% with 8 of 12 patients maintaining a stable AAO-HNS grade and GR score at follow-up. Mean tumor size was 1.5 cm (range: 1-2 cm). No patients experienced postoperative cerebrospinal fluid leak, infection, or cranial nerve palsy for a complication rate of 0%. Mean operative time was 261.6 minutes with an estimated blood loss of 56.3 mL and average length of hospital stay of 3.6 days. Conclusion A purely endoscopic approach is a safe and effective option for hearing preservation surgery for vestibular schwannomas in appropriately selected patients.
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Affiliation(s)
- Pradeep Setty
- Section of Neurosurgery, St John Providence Health System, Michigan State Unviersty, Southfield, Michigan, United States
| | - Kenneth P D'Andrea
- Section of Neurosurgery, St John Providence Health System, Michigan State Unviersty, Southfield, Michigan, United States
| | - Emily Z Stucken
- Department of Neurotology, Michigan Ear Institute, Farmington Hills, Michigan, United States
| | - Seilesh Babu
- Department of Neurotology, Michigan Ear Institute, Farmington Hills, Michigan, United States
| | - Michael J LaRouere
- Department of Neurotology, Michigan Ear Institute, Farmington Hills, Michigan, United States
| | - Daniel R Pieper
- Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
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