TITLE:
Endoscopic Assisted Microscopic Skull Base Surgery
AUTHORS:
Mohammed Attia, Islam Alaghoy, Magdy El Hawary, Maamon Abo-Shosha
KEYWORDS:
Skull Base, Endoscopic Assisted
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.8 No.2,
April
11,
2018
ABSTRACT: Background: Skull base tumors presented great challenge
for neurosurgeons since decades due to their deep location, associated
morbidity and limitation of operative field; however modern
neurosurgery using the endoscope and/or the microscope served in minimizing peri-operative morbidities and
improving the clinical outcome. Objective: To demonstrate the
value of endoscope-assisted microsurgical technique for resection of skull base tumors. Patients and
Methods: 30 patients divided into 3 groups (10 patients had medial sphenoid wing meningioma
constituted group 1, 10 patients had suprasellar meningioma constituted group
2 and 10 patients had Cerbello-Pontine Angle
(CPA) epidermoids constituted group 3) were operated through
Endoscope Assisted Microscopic Skull Base Surgery technique at Al-Azhar University
Hospitals during the period starting from January 2016
till the end of September 2017 using a rigid endoscope for inspection of
tumor boundaries and neighboring vascularity in addition to confirm the extent of resection.
Tumor resection was tried in all cases. Intra-operative resection rate and post-operative radiological outcomes were
assessed. Results: Total gross resection
was possible in 27 patients (90%). Subtotal resection was done in the other 3 cases (recurrent medial sphenoid wing
meningiomas) due to excessive bleeding and adhesions of the tumors with
vascular structures. Total resection of the tumor in post operative radiology was obtained in 24 patients (80%) and
post-operative residual tumor was noticed in 6 patients in early post operative radiology and in only 3 cases
at 3 months follow up radiology. Conclusion: Endoscopic-assisted
microsurgical approach is a reliable, safe and effective option for adequate
surgical resection of skull base tumors. The technique allowed proper
inspection of the tumor relations and vascularity, detection of any
residual portions, providing better chance for gross total resection with minimal tissue damage or
vascular injury as well as convenient clinical outcome.