title: Fully endoscopic retrosigmoid approach for posterior petrous meningioma and trigeminal microvascular decompression.
abstract: BACKGROUND
  Cerebellopontine angle tumor resection and cranial nerve microvascular decompression are usually performed with the aid of the surgical microscope. The endoscope is commonly used as an adjuvant.
  
  
  METHODS
  A retrosigmoid craniectomy is done. Upon dural opening, the endoscope is inserted into the operative field along the petrotentorial junction. Cerebrospinal fluid drainage provides a wider space for introduction of the endoscope and surgical instruments. Traditional microsurgical techniques are used during the entire procedure.
  
  
  CONCLUSIONS
  A fully endoscopic retrosigmoid approach is a safe and effective procedure for cerebellopontine angle tumor resection and cranial nerve microvascular decompression.
  
  
  CONCLUSIONS
  • Careful examination of preoperative studies is needed to identify anatomical peculiarities. • Patient positioning: the head must be gently flexed and its vertex gently tilted toward the floor. • Neurophysiologic monitoring and intraoperative navigation. • Craniectomy: partial exposure of the transverse and sigmoid sinuses. • Curvilinear dural incision reflected laterally to minimize the risk of sinus injury. • Opening the cerebellomedullary cistern for CSF drainage and cerebellar relaxation. • Dynamic endoscopy enhances depth perception and must be performed by a team with experience in endoscopic intracranial surgery. • Traditional microsurgical techniques have to be applied during the entire operation. • Multilayer reconstruction, including watertight dural closure. • Meningiomas causing brainstem shift are not suitable for endoscopic resection.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, Pittsburgh, PA, 15213, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Vaz-Guimaraes
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gardner
authors.forename: Juan C
authors.initials: JC
authors.lastname: Fernandez-Miranda
mesh_terms: D002530:Cerebellopontine Angle / Q000601:surgery*; D006801:Humans; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D061145:Microvascular Decompression Surgery / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D014276:Trigeminal Nerve / Q000601:surgery*