title: 3D HD Endoscopy in Skull Base Surgery: From Darkness to Light.
abstract: The introduction of modern endoscopy in neurosurgery brought light to one of the darkest areas: the skull base. In particular, the trans-nasal route allowed skull base surgeons to visualize and dominate the entire midline skull base. We analyzed our surgical series of 199 patients that were affected by several pathologies (pituitary adenomas, clivalchordomas, craniopharyngioma, Rathke's cleft cysts, tuberculum sellaemeningiomas, and craniovertebral junction pathologies with bulbar compression) and treated each by using a 3D-HD endoscope between December 2012 and December 2015 and reviewed the literature. We present our results in terms of tumor resections and decompression inpatients affected by craniovertebral junction pathologies. Analyzing our direct experience, as well as the literature, we can assert that the amount and accuracy of necessary movements in order to achieve a determined target are affected by the screen clarity and image resolution of the device. Additionally, the experience of the surgeon has an important role in the surgical outcome. Moreover, depth perception is critical in order to obtain precise and accurate movements. Our observations and the experts' opinion indicate that this modality provides improved surgical dexterity by affording the surgeon with depth perception while manipulating tissue and maneuvering the endoscope in the endonasal corridor, which is especially crucial in reducing the learning curve of young neurosurgeons.
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Altieri
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Tardivo
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pacca
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Pennacchietti
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Penner
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Garbossa
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ducati
authors.affiliation: 1st ENT Division, University School of Medicine, Turin, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Garzaro
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, University School of Medicine, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zenga
mesh_terms: D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*