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Published on: July 5, 2021
Endoscope-assisted microsurgical resection of skull base meningiomas
Henry W S Schroeder1, Anne-Katrin Hickmann, Jörg Baldauf
1Department of Neurosurgery, Ernst Moritz Arndt University, Sauerbruchstr, 17487, Greifswald, Germany. henry.schroeder@uni-greifswald.de
Abstract:
This study aims to determine the value of endoscope assistance in the microsurgical resection of skull base meningiomas. Fourty-six patients harboring a skull base meningioma underwent an endoscope-assisted microsurgical resection. In 30 patients (65%), tumor parts which could not be visualized under the microscope were detected with the endoscope. In 26 patients (56%), these tumor remnants were removed under endoscopic view. Gross total resection was achieved in 35 patients (76%) and near-total resection in 11 (24%). There was no surgical mortality. The major complication was new cranial nerve deficit. The application of endoscopes was most useful in the small supraorbital craniotomies to look under the ipsilateral optic nerve and internal carotid artery as well as to visualize the diaphragm sellae and olfactory groove. In the retrosigmoid craniotomies, the endoscope was beneficial to inspect the internal auditory canal, to look into Meckel's cave, or to inspect areas hidden behind the jugular tubercle and tentorial edge. There was no obvious complication related to the application of the endoscope. Endoscope assistance is particularly of value when skull base meningiomas are to be removed via small craniotomies to inspect blind corners which cannot be visualized in a straight line with the microscope. In addition, there is a benefit of using endoscopes with various angles of view in standard craniotomies and skull base approaches to look around bony and dural corners or to look behind neurovascular structures, by which the amount of skull base drilling and retraction to expose the tumor can be reduced.
Insights
Endoscope assistance significantly improves microsurgical resection of skull base meningiomas by revealing hidden tumor portions. This technique enhances gross total resection rates and minimizes the need for extensive drilling.
Area of Science:
- Neurosurgery
- Surgical Oncology
- Medical Technology
Background:
- Skull base meningiomas present significant surgical challenges due to their complex anatomical location.
- Traditional microsurgery can have limitations in visualizing and accessing all tumor margins.
- Minimally invasive techniques are continually being explored to improve surgical outcomes.
Purpose of the Study:
- To evaluate the efficacy and value of endoscope assistance in the microsurgical resection of skull base meningiomas.
- To determine if endoscopes can identify and facilitate the removal of residual tumor not visible with microscopy alone.
- To assess the impact of endoscope assistance on resection completeness and patient safety.
Main Methods:
- A prospective study involving 46 patients undergoing endoscope-assisted microsurgical resection of skull base meningiomas.
- Detailed documentation of tumor portions identified and resected using endoscopic visualization.
- Comparison of resection extent and complications between traditional and endoscope-assisted approaches.
Main Results:
- Endoscope assistance identified previously unseen tumor portions in 65% of patients (30/46).
- Tumor remnants were removed under endoscopic guidance in 56% of patients (26/46).
- Gross total resection was achieved in 76% (35/46) and near-total resection in 24% (11/46) with no surgical mortality.
Conclusions:
- Endoscope assistance is a valuable adjunct to microsurgery for skull base meningiomas, particularly in small craniotomies and for inspecting difficult-to-visualize areas.
- The use of angled endoscopes allows for improved visualization around bony and neurovascular structures, potentially reducing surgical trauma.
- Endoscope assistance enhances the ability to achieve complete tumor resection while minimizing operative risks.
