Assisted neuroendoscopy in microsurgery of acoustic neurinomas (vestibular shvannomas)
Keywords:
neuroma vestibular-cochlear nerve, surgical treatment, suboccipital retrosigmoid approache Assisting neuroendoscopy, facial nerve, intrameatal portionAbstract
The possibility of assisted neuroendoscopy use as an auxiliary method in microsurgical removal of acoustic neurinomas (vestibular shvannomas) of III–IV grade is discussed in this article. It is shown, that application of endoscope results in better visualization of neurovascular structures, surrounding the tumor, and in diminished invasive surgery. Endoscopic assistance allows improved identification and preservation of facial nerve in comparison to the traditional microsurgical excision (68,1% and 75,9% patients accordingly). The application of this method allowes to remove the intrameatal portion of tumor without the resection of back wall of internal meatal passage.
The following disadvantages of the method are discussed: the frequent blood soiling of the endoscope lens, the short-term visualization of narrow parts of operation field, the risk of injury to structures next to the shaft of the endoscope, technical problems when operating in a three-dimensional milieu and necessity of additional preparation of the part of operation field to the placement of endoscope shaft.
Neuroendoscopic assistance is safety and effective in cases of removal of acoustic neurinomas (vestibular shvannomas) of III–IV grade. Carrying out the role of specific anatomical “intelligence”, it diminishes the operation trauma.
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