Introduction: Endoscopic techniques in CPA surgery have been applied mainly in the context of minimally invasive craniotomies, and inspection of the microscopic blind spots. We report here on a technique that utilizes the use of the endoscope in CPA surgery in the aim of maximizing the radicality of tumor resection.
Methods: The endoscope is introduced under simultaneous microscopic and endoscopic viewings to avoid injury to CPA structures. We utilize three hands techniques so the surgeon freely performs the dissection under the endoscopic screen. We recorded the endoscope use; as extending the approach, discovering hidden pieces of tumors, preserving the neural structures, removal of the microscopically unreachable tumor and confirmation of total removal.
The extent of microscopic resection was categorized into (STR), (NTR), and microscopic total removal (MTR), these all re-evaluated after introducing the endoscope. Endoscopic verified total removal (EVTR), means no any residual at the end of surgery, postoperative MRI was used to evaluate the endoscopic view.
Results: In 26 cases, resection was considered total with the use of the microscope only (MTR). Eighteen (69.23%) of them showed residual tumor after using the endoscope.
Further dissection of endoscopically visualized residuals was attempted in 34 cases. in 30 of them (EVTR) was achieved. The total No. of (EVTR) was 38, from which the post operative MRI was totally clear in 31 cases (81.5%) and showed small residual tumor, (less than 5mm) in any diameter, in only 2 cases. Five cases showed postoperative enhanced changes. In this series, no direct mechanical injury to the CPA structures happened during this technique.
Conclusions: The simultaneous use of endoscope in combination with microscope increase the extent of CPA tumor resection and minimize the risks of injury to CPA structures. Also the endoscopic evaluation of the degree of resection is highly sensitive comparable to the postoperative MRI images.
Patient Care: we have hypothesis that this technique should improve the long term follow by increase the extent of tumor resection, hence prevent recurrence. also this technique minimizes the complications of endoscopic assisted surgery by introducing the endoscope, resuming dissection, under microscopic view to see crowded CPA structures behind the endoscopic eye.
Learning Objectives: • Introducing the technique of simultaneously using the microscope and endoscope in resection of CPA tumors, to overcome the shortcomings of endoscopic assisted techniques.
• Evaluating the use of endoscope in increasing the extent of CPA tumor resection.
• Evaluating the sensitivity of endoscopic view by the postoperative MRI.