Fully endoscopic excision of vestibular schwannomas

New applications for intracranial endoscopic surgery continue to evolve. The endoscope provides improved visualization of the skull base, where narrow recesses and angled trajectories impair the direct forward view of the operating microscope. Endoscopic surgery allows for a smaller craniotomy, less dissection and minimal retraction, without compromising the goals of the operation. Articles describing the use of angled endoscopes to assist microscopic removal of vestibular schwannomas suggest that endoscopes allow for complete visualization of the most lateral aspect of the internal auditory canal, identify exposed air cells, and provide more detailed images of the surrounding neurovascular structures. In this report we describe three fully endoscopic excisions of 2 - 3.5 cm vestibular schwannomas via 1.5 cm keyhole retrosigmoid craniotomies. The 0 degrees and 30 degrees endoscopes provided excellent exposure, allowing complete visualization of the most lateral aspect of the internal auditory canal, insuring complete tumor removal. The patients had excellent outcomes and were discharged within 72 hours post-operatively. From our experience we conclude that the endoscope is ideally suited for a minimally invasive retrosigmoid approach to vestibular schwannomas.