[A combination use of endoscope and microscope in cerebral pontine angle surgery]

Objective: To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle (CPA) surgery. Methods: A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively. The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas, 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma. Twenty cases of vestibular swannnomas, 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach, while other cases undergone the surgery via retrolabyrinthine approach. Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion. The surgical results were evaluated according to subjective and objective criteria, and all patients were followed up for 15 years. Results: The symptoms was disappeared in the cranial neuropathy patients, without facial paralysis, complication of other nerves or hearing loss. Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma, which gained completely surgical removal; useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up. Conclusions: A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques. It can provide better exposure with minimal invasion in CPA surgery, and is especially applicable in surgery for cranial neuropathy, vestibular schwannoma and CPA cholesteatoma, which should be performed through retrosigmoid approach and retrolabyrinthine approach.