Endoscopic-assisted Technique Research Articles

An endoscopic-assisted technique for the enlarged middle cranial fossa approach to the petroclival region: an anatomic study

Objective:Through the observation and measurement of the adjacent anatomical structures exposed by the pure microscope and endoscopic-assisted technique for the enlarged middle cranial fossa approach to the petroclival region, quantitative compare the advantages of endoscopic-assisted technique and the pure microscope exposure. Method:The enlarged middle cranial fossa approach was performed on 10 cases (20 sides) fresh adult cadaveric head specimens in which the vessels were injected with colored silicone. At the end of every enlarged middle cranial fossa approachs, endoscope assisted technique was applied. The effective working areas were measured under pure microscope and endoscopic-assisted technique. Result:The distance between the trigeminal nerve root entering the pons and the upper limit of exposure to the middle of the ventral brainstem under the microscope was（15.95±0.48）mm；the distance from the initial point of the acoustic-facial bundle to the lower bound of exposure to the middle of the ventral brainstem under the microscope was（10.79±0.51）mm；The distance between the trigeminal nerve root entering the pons and the upper limit of exposure to the middle of the ventral brainstem under endoscopy was（18.88±0.36）mm；the distance from the initial point of the acoustic-facial bundle to the lower bound of exposure to the middle of the ventral brainstem under endoscopy was（14.56±0.64）mm. Conclusion:In the anatomic study of the enlarged middle cranial fossa approach to the petroclival region, the endoscopic assistance has a larger effective exposure space and flexible perspective compared with the operation under the microscope, which is helpful to accurately locate the position and size of the lesion during surgery, accurately identify the important nerves and blood vessels surrounding the lesion, so as to improve the resection rate and reduce the recurrence rate.

Minimally Invasive Endoscopic-Assisted Technique for Implant Removal After Pelvic Bridge Plating.

Subcutaneous internal plate fixation for anterior pelvic ring injuries has become more common, but implants require removal, usually by 12 weeks. The purpose of this article is to report a novel, minimally invasive, endoscopic-assisted technique for the removal of subcutaneous anterior pelvic plates safely and atraumatically without violating the underlying fascia.

A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture.

In this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome. A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect. Of 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies. Endoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.

A systematic review of endoscopic versus open treatment of craniosynostosis. Part 2: the nonsagittal single sutures.

Despite increasing adoption of endoscopic techniques for repair of nonsagittal single-suture craniosynostosis, the efficacy and safety of the procedure relative to established open approaches are unknown. In this systematic review the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of metopic, unilateral coronal, and lambdoid craniosynostosis, with an emphasis on quantitative reported outcomes. A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Of 316 screened records, 7 studies were included in a qualitative synthesis of the evidence, of which none were eligible for meta-analysis. These reported on 111 unique patients with metopic, 65 with unilateral coronal, and 12 with lambdoid craniosynostosis. For all suture types, 100 (53%) children underwent endoscope-assisted craniosynostosis surgery and 32 (47%) patients underwent open repair. These studies all suggest that blood loss, transfusion rate, operating time, and length of hospital stay were superior for endoscopically treated children. Although potentially comparable or better cosmetic outcomes are reported, the paucity of evidence and considerable variability in outcomes preclude meaningful conclusions. Limited data comparing open and endoscopic treatments for metopic, unilateral coronal, and lambdoid synostosis suggest a benefit for endoscopic techniques with respect to blood loss, transfusion, length of stay, and operating time. This report highlights shortcomings in evidence and gaps in knowledge regarding endoscopic repair of nonsagittal single-suture craniosynostosis, emphasizing the need for further matched-control studies.

Endoscopic Assisted Microscopic Skull Base Surgery

Background: Skull base tumors presented great challenge for neurosurgeons since decades due to their deep location, associated morbidity and limitation of operative field; however modern neurosurgery using the endoscope and/or the microscope served in minimizing peri-operative morbidities and improving the clinical outcome. Objective: To demonstrate the value of endoscope-assisted microsurgical technique for resection of skull base tumors. Patients and Methods: 30 patients divided into 3 groups (10 patients had medial sphenoid wing meningioma constituted group 1, 10 patients had suprasellar meningioma constituted group 2 and 10 patients had Cerbello-Pontine Angle (CPA) epidermoids constituted group 3) were operated through Endoscope Assisted Microscopic Skull Base Surgery technique at Al-Azhar University Hospitals during the period starting from January 2016 till the end of September 2017 using a rigid endoscope for inspection of tumor boundaries and neighboring vascularity in addition to confirm the extent of resection. Tumor resection was tried in all cases. Intra-operative resection rate and post-operative radiological outcomes were assessed. Results: Total gross resection was possible in 27 patients (90%). Subtotal resection was done in the other 3 cases (recurrent medial sphenoid wing meningiomas) due to excessive bleeding and adhesions of the tumors with vascular structures. Total resection of the tumor in post operative radiology was obtained in 24 patients (80%) and post-operative residual tumor was noticed in 6 patients in early post operative radiology and in only 3 cases at 3 months follow up radiology. Conclusion: Endoscopic-assisted microsurgical approach is a reliable, safe and effective option for adequate surgical resection of skull base tumors. The technique allowed proper inspection of the tumor relations and vascularity, detection of any residual portions, providing better chance for gross total resection with minimal tissue damage or vascular injury as well as convenient clinical outcome.

Anthropometric Outcome Measures in Patients With Metopic Craniosynostosis.

Treatment of metopic craniosynostosis is performed by either fronto-orbital advancement (FOA) or endoscopic-assisted techniques. Interfrontal angle (IFA) is a validated measure of trigonocephaly, but requires a computed tomography scan. The most common direct measure to assess surgical outcome in patients with trigonocephaly is frontal width (ft-ft). The aim of this study is to determine if frontal width correlates with IFA and successful surgical correction 1 year after treatment. A review of current morphologic assessment techniques is also provided. Three-dimensional computed tomography scans (preoperative and 1 year postoperative) of patients who underwent FOA (n = 13) or endoscopic (n = 13) treatment of metopic craniosynostosis were reviewed. Age-matched scans of unaffected patients served as controls. Frontal width was measured by a straight line between the bilateral frontotemporal points. Measurements were performed by 2 experienced observers and compared to IFA. Mean frontal width at preoperative scan for endoscopic and open patients was 55 ± 0.6 and 64 ± 0.7 mm, respectively (Z-score 1.6 and -3.7). Mean frontal width at postoperative scan for endoscopic and open patients was 80 ± 0.4 and 81 ± 0.7 mm (Z-score 0.0 for both groups). Frontal width for endoscopic correction significantly correlated with IFA (r = 0.536, P = 0.005), as well as for the open patients (r = 0.704, P < 0.001). Frontal width normalizes 1 year after operation, regardless of technique. Advantage of frontal width is that it can be measured in the clinic using a spreading vernier caliper. It correlates well with IFA and can be used as a metric for morphologic outcome.

Endoscope-Assisted Microsurgical Subtemporal Keyhole Approach to the Posterolateral Suprasellar Region and Basal Cisterns.

Refinements in optics and instrumentation have enabled surgeons to approach deep-seated intracranial diseases with reduced exposure and brain retraction. The anterior subtemporal keyhole approach is a minimally invasive route to the posterolateral aspect of the suprasellar area and petroclival region. In this cadaveric study, we show the benefits of endoscope-assisted microsurgical techniques in the anterior subtemporal keyhole approach. The anterior subtemporal keyhole approach was performed bilaterally on 5 formalin-fixed human specimens using standard microneurosurgical methods. Dissections compared the exposure afforded by the microsurgical route with the endoscope-assisted technique, using 0° and30° angled rod-lenses. Anatomic relationships among the surgical target and the surrounding neurovascular structures were described. Endoscope-assisted maneuvers enhanced the operative view afforded by the microscope and helped to minimize parenchymal retraction and neurovascular injury. Endoscope-assisted microsurgery provides a panoramic picture of the surgical target and its surroundings. It enables the operator to see into hidden corners beyond the microsurgical view. The endoscope provides enhanced visualization of the neurovascular structures located in the posterolateral suprasellar region, basal cisterns, upper clivus and midclivus, and interpeduncular region. Endoscope-assisted microsurgery provides a means to approach selected lesions located in the posterolateral suprasellar region, perimesencephalic cisterns, and upper clivus and midclivus. The operative view can be maximized by introducing the 0° and 30° angled endoscopes. Minimally invasive techniques help to optimize surgical exposure and lessen parenchymal retraction, thus improving control of the surrounding neurovascular structures.

Direct and Oblique Approaches to the Craniovertebral Junction: Nuances of Microsurgical and Endoscope-Assisted Techniques Along with a Review of the Literature.

The aim of this review is to provide an update of the technical nuances of microsurgical and endoscopic-assisted approaches to the craniovertebral junction (transnasal, transoral, and transcervical), and to report on the available clinical results in order to identify the best strategy. A nonsystematic update of the reviews and reporting on the anatomical and clinical results of endoscopic-assisted and microsurgical approaches to the craniovertebral junction (CVJ) was performed. Pure endonasal and cervical endoscopic approaches still have some disadvantages, including their steep learning curves and their deeper surgical fields. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging option compared with standard microsurgical techniques for transoral approaches to the anterior CVJ. This approach should be considered as complementary to, rather than as an alternative to the traditional transoral-transpharyngeal approach. The transoral (microsurgical or video-assisted) approach with sparing of the soft palate still remains the gold standard compared with the "pure" transnasal and transcervical approaches, due to the wider working channel provided by the former technique. The transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus. Of particular interest is the evidence that advances in reduction techniques can avoid the ventral approach.

Transpalpebral Eyebrow Lift.

Forehead rejuvenation goals are to raise the eyebrow, attenuate forehead wrinkles, and decrease glabellar frown lines. Endoscopic forehead lift represents a significant progress, even replacing the classic coronal and pretriquial techniques. The transpalpebral eyebrow lift allows safe direct visualization of anatomic structures comparable to the allowed by the endoscopic-assisted technique but dispenses the endoscopic instrumentation, is less expensive, and takes less time to learn. Transpalpebral eyebrow lift is a technique that produces satisfactory results in mild-to-moderate eyebrow ptosis improving eyebrow lateral third ptosis and glabellar wrinkles.

Chimeric anterolateral thigh free flap for reconstruction of complex cranio-orbito-facial defects after skull base cancers resection.

Complex cranio-orbito-facial defects after skull base cancers resection entail a functional and esthetic reconstruction. The introduction of endoscopic assisted techniques for excision surgery with the advances in reconstructive surgery and anesthesiology allowed to improve the management of such critical patients. We report a series of chimeric anterolateral thigh (ALT) flaps used to reconstruct complex cranio-orbital-facial defects after skull base surgery. A retrospective review of patients that underwent cranio-orbito-facial reconstruction using a chimeric ALT flap from March 2013 to October 2015 at a single tertiary care referral Institute was performed. All patients were affected by locally-advanced malignant tumor and the resulting defects involved the skull base in all cases. The ALT flaps were perforator-based flaps with different components: fascia, skin and muscle. The different flap territories had independent vascular supply and were independent of any physical interconnection except where linked by a common source vessel. Ten patients were included in the study. Three patients underwent adjuvant radiotherapy and to chemotherapy. The mean hospitalization time was 21 days (range, 8-24 days). One failure was observed. After a mean follow-up of 12.4 months, 3 patients died of the disease, 2 are alive with disease, while 5 patients (50%) are currently alive without evidence of disease. Chimeric ALT flap is a reliable and versatile reconstructive option for complex cranio-orbito-facial defects resulting from skull base surgery. The chimeric flap composed of different territories proved to be adequate for a patient-tailored three-dimensional reconstruction of the defects as well as able to resist to the postoperative adjuvant treatments.

The diagnosis and treatment for pyriform sinus fistula in children

Objective: To discuss the diagnosis and management for pyriform sinus fistula in children. Methods: Eight cases of pyriform sinus fistula admitted in Guangzhou Women and Children's Medical Center from May 2013 to August 2015 were retrospectively analyzed. The median age at onset was 54 months (range from 11 months to 12 years). All 8 cases presented recurrent neck infection (typical of redness, swelling, heat and pain) and 2 accompanied with acute suppurative thyroiditis. The diagnosis was confirmed by the preoperative barium esophagography combined with neck computed tomography scan (plain scan, enhancement and reconstruction). All the patients underwent laryngeal endoscopic-assisted surgery. Results: Preoperative imaging findings identified seven left-side cases and one bilateral (the symptom only manifested on left side). All 8 cases underwent left fistulectomy. There was no esophageal injury nor nerve injury during the operation. Postoperatively, all cases recovered well without complications (such as sound hoarse and coughing) and reoccurrence within the follow-up period (range from 7 months to 34 months). Conclusions: Preoperative barium esophagogram combined with neck computed tomography scan facilitates proper diagnosis and appropriate treatment. Laryngeal endoscopic-assisted technique at operation provides a better understanding of the anatomic relationship and the points where the fistulas penetrated into the pharynx, and essentially improves the operation outcome.

Update on mandibular condylar fracture management.

Fractures of the mandibular condyle have provided a lasting source of controversy in the field of facial trauma. Concerns regarding facial nerve injury as well as reasonable functional outcomes with closed management led to a reluctance to treat with an open operative intervention. This article reviews how incorporating new technologies and surgical methods have changed the treatment paradigm. Multiple large studies and meta-analyses continue to demonstrate superior outcomes for condylar fractures when managed surgically. Innovations, including endoscopic techniques, three-dimensional miniplates, and angled drills provide increased options in the treatment of condylar fractures. The literature on pediatric condylar fractures is limited and continues to favor a more conservative approach. There continues to be mounting evidence in radiographic, quality of life, and functional outcome studies to support open reduction with internal fixation for the treatment of condylar fractures in patients with malocclusion, significant displacement, or dislocation of the temporomandibular joint. The utilization of three-dimensional trapezoidal miniplates has shown improved outcomes and theoretically enhanced biomechanical properties when compared with traditional fixation with single or double miniplates. Endoscopic-assisted techniques can decrease surgical morbidity, but are technically challenging, require skilled assistants, and utilize specialized equipment.

Simultaneous Transventricular-Orbitocranial Resection of Large Suprasellar Craniopharyngioma as Inspired by Jackson's Maneuver from 1863.

Traditional skull base techniques utilizing the microscope have allowed surgeons improved safe access to deep-seated lesions. More recent technical advances with the endoscope have allowed improved visibility and access to these previously difficult-to-reach regions. Most current literature emphasizes one technique over the other. We present a unique hybrid-type approach that tackles this not-infrequent surgical dilemma. This hybrid-type surgery resulted in a new technique that is a confluence of both open microsurgery and skull base corridors with an endoscope. Furthermore, a combined ventriculoscope approach adds extended assistance with resection. We detail the utility of this technique.A patient presented with a large suprasellar lesion that was suspicious for a craniopharyngioma. Given improved survival with extent of resection, the goal of surgical intervention was maximal safe resection. The location of the tumor would have involved certain morbidity with deliberate residual if a skull base approach or endoscope-based approach was employed independently. As a result, the patient underwent a hybrid-type operation using a multi-corridor split-surgical team approach for the resection of her tumor.The patient underwent hybrid surgery via a combined open microsurgical craniotomy, endoscopic resection, and a ventriculoscope-assisted approach. The ventriculoscope access allowed for resection of the intraventricular portion of the tumor and guided the extent of resection from the microsurgical corridor. Additionally, from a separate craniotomy, the suprasellar component was resected using both standard skull base and endoscope-assisted techniques. The patient tolerated the procedure well without additional morbidity provided from the multi-corridor hybrid technique.The hybrid surgery resulted in a new multi-modality, split-surgical team approach providing maximal visualization with minimal added morbidity to resect a lesion difficult to access. This hybrid technique may be an effective piece of the surgeon’s armamentarium to provide improved patient outcomes.

Endoscopic inter laminar management of lumbar disease

Discectomy for lumbar disc provides faster relief in acute attack than does conservative management. Long-term results of open, microscopy-, and endoscopy-assisted discectomy are same. Early results of endoscopy-assisted surgery are better as compared to that of open surgery in terms of better visualization, smaller incision, reduced hospital stay, better education, lower cost, less pain, early return to work, and rehabilitation. Although microscopic discectomy also has comparable advantages, endoscopic-assisted technique better addresses opposite side pathology. Inter laminar technique (ILT) and trans foraminal technique (TFT) are two main endoscopic approaches for lumbar pathologies. Endoscopy-assisted ILT can be performed in recurrent, migrated, and calcified discs. All lumbar levels including L5-S1 level, intracanalicular, foraminal disc, lumbar canal and lateral recess stenosis, multiple levels, and bilateral lesions can be managed by ILT. Migrated, calcified discs, L5-S1 pathology, lumbar canal, and lateral recess stenosis can be better approached by ILT than by TFT. Most spinal surgeons are familiar with anatomy of ILT. It can be safely performed in foramen stenosis and in uncooperative and anxious patients. There is less risk of exiting nerve root damage, especially in short pedicles and in presence of facet osteophytes as compared to TFT. On the other hand, ILT is more invasive than TFT with more chances of perforations of the dura matter, pseudomeningocele formation, and cerebrospinal fluid fistula in early learning curve. Obtaining microsurgical experience, attending workshops, and suitable patient selection can help shorten the learning curve. Once adequate skill is acquired, this procedure is safe and effective. The surgeon must be prepared to convert to an open procedure, especially in early learning curve. Spinal endoscopy is likely to achieve more roles in future. Endoscopy-assisted ILT is a safer alternative to the microscopic technique.

Endoscopic-assisted epiphysiodesis

The aim of the study was to describe the endoscopic-assisted epiphysiodesis technique and review our 20-year experience with it. A retrospective review of 44 patients who underwent proximal tibia and/or distal femur endoscopic-assisted epiphysiodesis was carried out. Only patients who had preoperative and postoperative scanograms with clinical follow-up of at least 6 months were included. The mean length of follow-up was 36.8 months. All patients had radiographic evidence of physeal fusion within 6-12 months from the index procedure. No patient required revision surgery. Endoscopic-assisted epiphysiodesis is safe, effective, and achieves predictable physeal fusion. Advantages over current techniques include reduced radiation exposure and lack of requirement for hardware placement.

Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis.

Confocal laser endomicroscopy (CLE) is an endoscopic-assisted technique developed to obtain histopathological diagnoses of gastrointestinal and pancreatobiliary diseases in real time. The objective of this systematic review is to analyze the current literature on CLE and to evaluate the applicability and diagnostic yield of CLE in patients with gastrointestinal and pancreatobiliary diseases. A literature search was performed on MEDLINE, EMBASE, Scopus, and Cochrane Oral Health Group Specialized Register, using pertinent keywords without time limitations. Both prospective and retrospective clinical studies that evaluated the sensitivity, specificity, or accuracy of CLE were eligible for inclusion. Of 662 articles identified, 102 studies were included in the systematic review. The studies were conducted between 2004 and 2015 in 16 different countries. CLE demonstrated high sensitivity and specificity in the detection of dysplasia in Barrett's esophagus, gastric neoplasms and polyps, colorectal cancers in inflammatory bowel disease, malignant pancreatobiliary strictures, and pancreatic cysts. Although CLE has several promising applications, its use has been limited by its low availability, high cost, and need of specific operator training. Further clinical trials with a particular focus on cost-effectiveness and medicoeconomic analyses, as well as standardized institutional training, are advocated to implement CLE in routine clinical practice.

Endoscopic-assisted removal of traumatic brain hemorrhage: case report and technical note

The endoscopic technique has been described as a minimally invasive method for spontaneous hematoma evacuation, as a safe and effective treatment. Nevertheless, to our knowledge, there is no description of a technical report of traumatic intracerebral hematoma removal using the neuroendoscope. A 47-year-old man was admitted sustaining 13 points in Glasgow coma scale with brain computed tomography (CT) scan showing a temporal contusion. Guided by a 3D reconstructed CT, using the program OsiriX®, the posterior limit of the hematoma was identified. A burr hole was placed at the posterior temporal region, and we used the neuroendoscope to assist the hematoma evacuation. The postoperative tomography showed adequate hematoma removal. He was discharged from hospital 48 h after surgery. Two weeks later, he was conscious and oriented temporally. This endoscopic-assisted technique can provide safe removal of traumatic hematomas of the temporal lobe.

Less Is More? Quantitative Comparison of Endoscopic-Assisted Techniques in the Management of Sagittal Synostosis

Less Is More? Quantitative Comparison of Endoscopic-Assisted Techniques in the Management of Sagittal Synostosis

The combined microscopic-endoscopic technique for radical resection of cerebellopontine angle tumors.

The combined microscopic and endoscopic technique has shown significant advantages in the management of various lesions through different approaches. Endoscopic-assisted techniques have frequently been applied to cerebellopontine angle (CPA) surgery in the context of minimally invasive craniotomies. In this paper the authors report on the use of the endoscope in the CPA as a tool to increase the extent of resection, minimize complications, and preserve the function of the delicate CPA structures. They also describe a technique of the simultaneous use of the microscope and endoscope in the CPA and dissection of CPA tumors under tandem endoscopic and microscopic vision to overcome the shortcomings of introducing the endoscope alone in the CPA. The reliability of using the microscope alone in dissecting CPA tumors is evaluated, as is the effectiveness of the combined technique in increasing the resectability of various types of CPA tumors. The authors conducted a retrospective analysis of 50 patients who underwent combined microscopic-endoscopic resection of CPA tumors by the senior author over a period of 3 years (February 2011 to February 2014) at Brigham and Women's Hospital, Harvard Medical School. The reliability of the extent of microscopic removal was evaluated with endoscopic exploration. Additional resection was performed with both microscopic and the combined microscopic-endoscopic technique. Endoscopically verified total resection was validated by intraoperative or postoperative MRI. The function of the cranial nerves was evaluated to assess the impact of the combined technique on their function. A tumor remnant was endoscopically identified in 69% of the 26 patients who were believed to have microscopic total resection. The utilization of the endoscopic visualization and dissection increased endoscopically verified total removal to 38 patients, and 82% of these patients had no sign of residual tumor on postoperative imaging. The technique was most effective with epidermoid tumors. There were a total of 17 new cranial nerve deficits in 10 patients. Preoperative fifth cranial nerve deficits improved in 52% and hearing improved in 29% of patients after surgery. This method provides simultaneous microscopic and endoscopic visualization and dissection techniques through skull-base approaches to CPA tumors. It overcomes some of the shortcomings of endoscopic-assisted surgery, further extends the surgical field, and increases the radicality of tumor resection with good functional outcomes.

Endoscopic Evacuation of Subdural Collections.

Intraoperative use of the endoscope is a hot topic in neurosurgery and it gives broader visualization of critical and hardlyreached areas. Endoscope-assisted surgical approach to chronic subdural haematoma (SDH) is a minimally invasive technique and may give an expansion to the regular method of burr-hole haematoma drainage. Endoscope-assisted haematoma drainage with mini-craniotomy was performed over a 24-month period, and prospectively collected data is reviewed. A total of 10 procedures (8 patients) were performed using the endoscopeassisted technique. Four of them were chronic SDH and six were subacute SDH. Procedures were extended 20 minutes in average because of endoscopic intervention. There was no extra-morbidity through the study as a consequence of endoscopic assessment. Endoscope-assisted techniques can make the operation safe in selected circumstances with improved intraoperative visualization. It may likewise take into consideration the identification and destruction of neo-membranes, septums and solid clots. In addition, the source of bleeding can be easily coagulated. The endoscope-assisted techniques, with all of these features, can alter the pre- and intra-operative decision-making for selected patients.