caa a22 4500 606215751 CHVBK 20210128101100.0 cr unu---uuuuu 210128e20150401xx s 000 0 eng 10.1007/s00701-014-2332-1 doi (NATIONALLICENCE)springer-10.1007/s00701-014-2332-1 Fully endoscopic retrosigmoid approach for posterior petrous meningioma and trigeminal microvascular decompression [Elektronische Daten] [Francisco Vaz-Guimaraes, Paul Gardner, Juan Fernandez-Miranda] 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. Method: 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. Conclusion: A fully endoscopic retrosigmoid approach is a safe and effective procedure for cerebellopontine angle tumor resection and cranial nerve microvascular decompression. Key points: • 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. Springer-Verlag Wien, 2015 Retrosigmoid approach nationallicence Endoscope nationallicence Posterior petrous meningioma nationallicence Microvascular decompression nationallicence Vaz-Guimaraes Francisco Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, 15213, Pittsburgh, PA, USA aut Gardner Paul Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, 15213, Pittsburgh, PA, USA aut Fernandez-Miranda Juan Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, 15213, Pittsburgh, PA, USA aut Acta Neurochirurgica Springer Vienna 157/4(2015-04-01), 611-615 0001-6268 157:4<611 2015 157 701 https://doi.org/10.1007/s00701-014-2332-1 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2332-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Vaz-Guimaraes Francisco Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, 15213, Pittsburgh, PA, USA aut NATIONALLICENCE 700 1- Gardner Paul Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, 15213, Pittsburgh, PA, USA aut NATIONALLICENCE 700 1- Fernandez-Miranda Juan Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, UPMC Presbyterian, 15213, Pittsburgh, PA, USA aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/4(2015-04-01), 611-615 0001-6268 157:4<611 2015 157 701