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Adjunctive Use of Endoscopy during Posterior Fossa Surgery to Treat Cranial Neuropathies

King, Wesley A. M.D.; Wackym, Phillip A. M.D.; Sen, Chandranath M.D.; Meyer, Glenn A. M.D.; Shiau, John M.D.; Deutsch, Harel M.D.

Technique Assessment

OBJECTIVE: The objective of this study was to determine the utility and safety of rigid endoscopy as an adjunct during posterior fossa surgery to treat cranial neuropathies.

METHODS: A suboccipital craniotomy was performed for 19 patients with non-neoplastic processes involving the Vth, VIIth, and/or VIIIth cranial nerves. Ten patients with trigeminal neuralgia (n = 8), hemifacial spasm (n = 1), or intractable tinnitus (n = 1) underwent primarily microvascular decompression procedures. One patient with geniculate neuralgia underwent nervus intermedius sectioning combined with microvascular decompression. Eight patients underwent unilateral vestibular nerve neurectomies for treatment of Ménière’s disease. A 0- or 30-degree rigid endoscope was used in conjunction with the standard microscopic approach for all procedures.

RESULTS: All patients experienced resolution or significant improvement of their preoperative symptoms after posterior fossa surgery. The endoscope allowed improved definition of anatomic neurovascular relationships without the need for significant cerebellar or brainstem retraction. Cleavage planes between the cochlear and vestibular nerves entering the internal auditory canal and sites of vascular compression could not be microscopically observed for several patients; however, endoscopic identification was possible for all patients. There were no complications related to the use of the endoscope.

CONCLUSION: The rigid endoscope can be used safely during posterior fossa surgery to treat cranial neuropathies, and it allows improved observation of the cranial nerves, nerve cleavage planes, and vascular anatomic features without significant cerebellar or brainstem retraction.

Department of Neurosurgery (WAK, CS, JS, HD), Mount Sinai School of Medicine, New York, New York, and Departments of Otolaryngology and Communication Sciences (PAW) and Neurosurgery (GAM), Medical College of Wisconsin, Milwaukee, Wisconsin

Received, October 26, 2000.

Accepted, February 22, 2001.

Reprint requests: Wesley A. King, M.D., Department of Neurosurgery, Box 1136, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029.

Copyright © by the Congress of Neurological Surgeons