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When should we be using an endoscope for cerebello-pontine angle lesions and what are the caveats?
EANS Academy. Alamri B. 09/25/19; 275409; EP04108
Mr. Bagher Alamri
Mr. Bagher Alamri

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Abstract
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Background: Surgery for cerebello-pontine angle (CPA) lesions is turning towards endoscopic-assisted microsurgery. The traditional narrow surgical corridor provided by a light microscope is augmented by the use of a neurendoscope that can 'see round corners', as well as the ability to perform more minimally invasive, endoscope-only skull-base surgery. The authors describe their experiences of using endoscope-only and endoscope-assisted approaches to cerebello-pontine angle (CPA) lesions, including a rationale for patient selection as well as technical limitations that should be considered when using these techniques.
Methods: A prospective observational study of patients undergoing CPA lesion resection who were selected for endoscopic anatomical evaluation and/or endoscope-guided lesion resection. CPA tumours without mass lesions were excluded. 10 cases of CPA lesions were identified pre-operatively for intra-operative endoscopic guidance across two neurosurgical centres.
Results: 10 cases were selected over a one-year period. Histology across the cases revealed 3 vestibular schwannomas (VS) (30%), a cyst (10%), epidermoid tumours (30%), meningiomata (30%). Three cases were carried out fully endoscopically (including two VS and the cyst). Four cases were carried out with endoscopic assistance and the endoscope was used in three cases primarily for anatomical orientation.
Conclusions: The use of the endoscope can be applied broadly across various CPA pathologies, either as an alternative to the operating microscope, as an adjunct to lesion resection or to allow anatomical examination in instances where operating microscope ergonomics and optics do not allow for clear lesion visualisation.
The endoscope is particularly useful in the identification of critical cranial nerve and CPA vascular structures, as well as identifying lesion residuum that would otherwise have been left behind, aiding in better total resection.
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