Archives of Neurosurgery Volume 1 Issue 1 Article 5 2020 Endoscopic–assisted surgery for cerebello pontine angle pathology: Technical note and surgical results in a series of patients Jaime Jesus Martinez Anda Neurosurgery Department, Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces, State of Mexico, Mexico, [email protected] Pablo David Guerrero Suarez Neurosurgery Department, Toluca Medical Center of Social Security Institute of the State of Mexico, [email protected] See next page for additional authors Follow this and additional works at: https://www.ansjournal.org/home Part of the Neurology Commons, Neuroscience and Neurobiology Commons, Neurosurgery Commons, and the Surgery Commons Recommended Citation Martinez Anda, Jaime Jesus; Guerrero Suarez, Pablo David; Pineda Martínez, Diego; Avendaño Pradel, Rafael; Jurado Delgado, Ernesto Javier; Villlagrana Sánchez, Ricardo Santiago; Cisneros Lesser, Juan Carlos; De la Llata Segura, Carolina; and Revuelta Gutiérrez, Rogelio (2020) "Endoscopic–assisted surgery for cerebello pontine angle pathology: Technical note and surgical results in a series of patients," Archives of Neurosurgery: Vol. 1 : Iss. 1 , Article 5. Available at: https://www.ansjournal.org/home/vol1/iss1/5 This Original Research - Endoscopy is brought to you for free and open access by Archives of Neurosurgery. It has been accepted for inclusion in Archives of Neurosurgery by an authorized editor of Archives of Neurosurgery. For more information, please contact [email protected]. Endoscopic–assisted surgery for cerebello pontine angle pathology: Technical note and surgical results in a series of patients Abstract Objectives: Endoscopic–assisted surgery combined with the operating microscope has been described for several surgical techniques and pathologies of the cerebellopontine angle (CPA). The use of an endoscope allows for a panoramic view of the CPA cistern and a high degree of maneuverability in narrow cisternal spaces that enable the surgeon to deal with most CPA lesions safely. We performed an observational study to describe the surgical anatomy and technique for endoscopic-assisted CPA surgery, describing our experience in a case series of patients with CPA pathology. Methods: Anatomical and surgical technique description of endoscopic-assisted surgery for CPA pathology, based on observations on a case series of patients surgically treated with an endoscopic–assisted keyhole retrosigmoid craniotomy. Results: Ten patients were treated with the following diagnosis: Trigeminal neuralgia (5 patients), epidermoid cyst (2 patients), hemifacial spasm (1 patient), vestibular paroxysms (1 patient), CPA neurocysticercosis (1 patient). The mean age was 48 years old, seven female and three male patients. All patients had resolution or improvement of their clinical symptoms. We describe the anatomic corridors for endoscopic–assisted surgery and surgical pearls. Conclusions: Endoscopic-assisted microsurgery of the CPA is a safe and efficient procedure that has demonstrated improved surgical results as compared to the full-microscopic technique. Visual Abstract Keywords Neuroendoscopy, Cerebellopontine angle, Surgical anatomy. Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 License. Cover Page Footnote Founding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non- financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Authors Jaime Jesus Martinez Anda, Pablo David Guerrero Suarez, Diego Pineda Martínez, Rafael Avendaño Pradel, Ernesto Javier Jurado Delgado, Ricardo Santiago Villlagrana Sánchez, Juan Carlos Cisneros Lesser, Carolina De la Llata Segura, and Rogelio Revuelta Gutiérrez This original research - endoscopy is available in Archives of Neurosurgery: https://www.ansjournal.org/home/vol1/ iss1/5 Endoscopice Assisted Surgery for Cerebello Pontine Angle Pathology: Technical Note and Surgical Results in a Series of Patients ORIGINAL RESEARCH Jaime Jesús Martínez e Anda a,*, Pablo David Guerrero e Suarez a, Diego Pineda e Martínez b, Rafael Avendano~ e Pradel b, Ernesto Javier Delgado e Jurado a, Ricardo Santiago Villagrana - Sanchez a, Juan Carlos Cisneros e Lesser c, Carolina de la Llata Segura d, Rogelio Revuelta e Gutierrez e a Neurosurgery Department, Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces, Baja Velocidad Avenue 57.5 Km, Mexico e Toluca Highway No.1519 Ote. Col. San Jeronimo Chicahualco, P.C. 52140, Metepec, Mexico b Human Biological Material Innovation Department, Faculty of Medicine, National Autonomous University of Mexico, University Campus, Coyoacan P.C. 04510, Mexico City, Mexico c Neurotology and Cranial Base Surgery Department. National Institute of Rehabilitation, Mexico-Xochimilco Avenue No. 289, Coapa, Arenal Tepepan, Tlalpan, P.C. 14389, Mexico City, Mexico d Otolaringology Department, Medica Sur Medical Center, Puente de Piedra Avenue No. 150. Col. Toriello Guerra, Tlalpan, P.C. 14050, Mexico City, Mexico e Neurosurgery Department, National Institute of Neurology and Neurosurgery, Insurgentes Sur Avenue No. 3877, La Fama, Tlalpan, P.C. 14269, Mexico City, Mexico Abstract Objectives: Endoscopiceassisted surgery combined with the operating microscope has been described for several surgical techniques and pathologies of the cerebellopontine angle (CPA). The use of an endoscope allows for a pano- ramic view of the CPA cistern and a high degree of maneuverability in narrow cisternal spaces that enable the surgeon to deal with most CPA lesions safely. We performed an observational study to describe the surgical anatomy and technique for endoscopic-assisted CPA surgery, describing our experience in a case series of patients with CPA pathology. Methods: Anatomical and surgical technique description of endoscopic-assisted surgery for CPA pathology, based on observations on a case series of patients surgically treated with an endoscopiceassisted keyhole retrosigmoid craniotomy. Results: Ten patients were treated with the following diagnosis: Trigeminal neuralgia (5 patients), epidermoid cyst (2 patients), hemifacial spasm (1 patient), vestibular paroxysms (1 patient), CPA neurocysticercosis (1 patient). The mean age was 48 years old, seven female and three male patients. All patients had resolution or improvement of their clinical symptoms. We describe the anatomic corridors for endoscopiceassisted surgery and surgical pearls. Conclusions: Endoscopic-assisted microsurgery of the CPA is a safe and efficient procedure that has demonstrated improved surgical results as compared to the full-microscopic technique. Keywords: Neuroendoscopy, Cerebellopontine angle, Surgical anatomy Received 23 May 2020; revised 11 July 2020; accepted 15 July 2020. Available online 15 April 2021 * Corresponding author. Neurosurgery Department, Toluca Medical Center of Social Security Institute of the State of Mexico and Provinces, Baja Velocidad Avenue 57.5 Km, Mexico e Toluca Highway No.1519 Ote. Col. San Jeronimo Chicahualco, P.C. 52140, Metepec. Mexico. E-mail addresses: [email protected] (J.J. Martínez e Anda), [email protected] (P.D. Guerrero e Suarez), [email protected] (D. Pineda e Martínez), [email protected] (R. Avendano~ e Pradel), [email protected] (E.J. Delgado e Jurado), [email protected] (R.S. Villagrana - Sanchez), [email protected] (J.C. Cisneros e Lesser), [email protected] (C. de la Llata Segura), [email protected] (R. Revuelta e Gutierrez). ISSN- Pending. Published by Mexican Society of Neurological Surgery (Sociedad Mexicana de Cirugía Neurológica A.C.). © Copyright the Authors. This journal is open access. 36 JAIME JESÚS MARTINEZ - ANDA ET AL Archives of Neurosurgery ENDOSCOPIC SURGERY OF CEREBELLO PONTINE ANGLE 2021;1(1):35e47 ORIGINAL RESEARCH 1. Introduction Abbreviations he retrosigmoid (RS) approach is the work- RS Retrosigmoid T horse for the surgical treatment of the cer- CPA Cerebellopontine Angle ebellopontine angle (CPA) pathologies. BNI Barrow Neurological Institute REZ Root Entry Zone Microsurgery has proven to be a major techno- CSF Cerebrospinal Fluid logical advance to increase efficacy and safety but AICA Antero e Inferior Cerebellar Artery CN Cranial Nerve has its limitations during CPA procedures. To SUCA Superior Cerebellar Artery solve some of those limitations, technical ad- PICA Postero e Inferior Cerebellar Artery vances in minimally invasive neurosurgery have enabled the use of endoscopic techniques with high definition equipment that allows the explo- 2.1. Inclusion criteria were ration of every corner in the surgical field, 1. Patients with CPA vascular syndromes where no enhancing the view and illumination [1]. Endo- vascular compression was seen on preoperative scopic techniques combined with the operating MRI or during the microscopic technique, microscope have been described for several 2. Epidermoid cysts of the CPA, and techniques