Endoscopic retrosigmoid keyhole approach in cerebellopontine angle tumors. A surgical cohort.

INTRODUCTION AND OBJECTIVES: To determine the safety and efficacy of endoscopic keyhole surgery in patients with cerebellopontine angle tumours. MATERIALS AND METHODS: This was a retrospective study of patients with cerebellopontine angled tumours treated by fully endoscopic retrosigmoid keyhole approach in a tertiary centre during a period of four years. Preoperative, transoperative and postoperative variables were analysed. RESULTS: A number of 40 patients were included. The age average was 49.4 years and male/female proportion was 0.4-1. We found 31 vestibular schwannomas (77.5%), five meningiomas (12.5%), two cholesteatomas (5.0%) and two metastases (5.0%). Vestibular schwannomas Hannover type IIIb, IVa and IVb predominated. The surgical resection was total or near-total 92.5% of patients. Hearing preservation rate was 62.5% and acceptable facial function nerve function rate was 80% after six months. Hospital stay was 7.5 days. The total or near total resection and functionally preservation rate was high. Complications were unusual. CONCLUSIONS: Endoscopic retrosigmoid keyhole approach represented a safe and efficient procedure in selected patients with cerebellopontine angle tumours.

Minimally Invasive 360-Degree Approach to Intraconal Orbital Tumors.

PURPOSE: To evaluate clinically the efficacy of 360-degree minimally invasive endoscopic surgery in patients with orbital intraconal tumors. DESIGN: Retrospective interventional case series. METHODS: A series of consecutive patients with orbital intraconal tumors were treated with minimally invasive surgery using an endonasal endoscopic approach or an anterior endoscopic orbitotomy over a 5-year period between January 2015 and January 2020 at the National Institute of Oncology and Radiobiology of Cuba. RESULTS: In 22 patients, the mean age was 52.3 ± 11 years (range 18-71 years) with a female to male ratio of 1.8:1. Visual loss was present in 3 patients and proptosis was present in 19 patients. The most common diagnosis was cavernous hemangioma (72.7%) followed by orbital sheet meningioma (9.1%). The lower-inner (type II) location was the most usual, followed by the lower-outer (type IV). A gross total resection was achieved in 95.5% of patients. In only 1 case with an orbital pseudotumor was the resection subtotal because of the fibrous consistency, irregularity, and adherences to the medial rectus muscle. All patients with visual loss improved to normal visual function after surgery at follow-up and orbital proptosis recovered in all patients with these symptoms. Both immediate and long-term morphologic and aesthetic results were good in all patients. CONCLUSION: The minimally invasive 360-degree surgical approach with a full endoscopic visualization can be safe and efficient in patients with select orbital intraconal tumors. Optic nerve location constitutes the main aspect in the surgical approach selection. A large case series is necessary to standardize this surgical philosophy.

Endoscopic retrosigmoid keyhole approach in cerebellopontine angle tumors. A surgical cohort. / Keyhole endoscópico retrosigmoideo en tumores del ángulo pontocerebeloso. Resultados de una serie.

INTRODUCTION AND OBJECTIVES: To determine the safety and efficacy of endoscopic keyhole surgery in patients with cerebellopontine angle tumors. MATERIALS AND METHODS: This was a retrospective study of patients with cerebellopontine angled tumors treated by fully endoscopic retrosigmoid keyhole approach in a tertiary center during a period of four years. Preoperative, transoperative and postoperative variables were analyzed. RESULTS: A number of 40 patients were included. The age average was 49.4 years and male/female proportion was 0.4-1. We found 31 vestibular schwannomas (77.5%), five meningiomas (12,5%), two cholesteatomas (5,0%) and two metastases (5.0%). Vestibular schwannomas Hannover type IIIb, IVa and IVb predominated. The surgical resection was total or near-total 92.5% of patients. Hearing preservation rate was 62.5% and acceptable facial function nerve function rate was 80% after six months. Hospital stay was 7.5 days. The total or near total resection and functionally preservation rate was high. Complications were unusual. CONCLUSIONS: Endoscopic retrosigmoid keyhole approach represented a safe and efficient procedure in selected patients with cerebellopontine angle tumors.

Tumor pineal resuelto por Abordaje Infratentorial Supracerebeloso Endoscópico. Reporte de un caso y revisión de la literatura / Pineal tumor resolved by Endoscopic Supracerebellar Infratentorial Approach. Case report and literature review

Introducción: Los tumores de la región pineal constituyen un grupo heterogéneo de lesiones localizadas en la porción posterior del tercer ventrículo bajo el esplenio del cuerpo calloso y encima de la lámina cuadrigémina. Dentro de estos, los tumores del parénquima pineal constituyen un grupo frecuente. En estas lesiones no existe actualmente un protocolo establecido debido a la ausencia de grandes series. Se sugiere una combinación de cirugía y radioterapia con o sin quimioterapia. El tratamiento de elección es la resección total, sin embargo, muchas veces no es posible por dificultades técnicas. En este contexto, la cirugía con visualización endoscópica puede contribuir a lograr este objetivo. Descripción del caso: Se presenta un paciente masculino de 22 años de edad con lesión de región pineal e hidrocefalia obstructiva triventricular al que se le practicó una tercerventriculostomía endoscópica y un abordaje infratentorial supracerebeloso con total visualización endoscópica. Se describe la técnica quirúrgica y se realiza un análisis crítico de la literatura actualizada. Conclusiones: Los tumores de la región pineal constituyen un reto terapéutico. La resección total es el principal objetivo en lesiones de grado intermedio o bajo de malignidad. El abordaje infratentorial supracerebeloso con total visualización endoscópica es efectivo en la resección quirúrgica de estas lesiones al mejorar la visualización y minimizar la retracción cerebelosa

Introduction: Pineal region tumors are a variable group of lesions located in the posterior wall of the third ventricle under the corpus callous splenium and above the tectal plate. Pineal gland tumors are frequent. There is not a standard protocol in these lesions due the lack of large series. A combination of surgery and chemo therapy or radiotherapy are recommended. The complete surgical resection is the treatment of choice. However, usually it is not possible to accomplished this goal due to technical limitations. In this scenario, the endoscopic visualization could contribute to archive the goal. Patient characteristics: A 22 years old young male patient with a pineal region lesion and obstructive hydrocephalus is presented. A third ventriculostomy was performed and an infratentorial supracerebelous approach with fully endoscopic visualization. The surgical technique is described and a critical review of literature is performed. Conclusions: Pineal region tumors represents a therapeutic challenge. Total removal is the most important objective in intermediate or low-grade lesions. The infratentorial supracerebelous approach with full endoscopic visualization is effective and improve the visualization while reducing the cerebellar retraction.