2025 Proffered Presentations
S093: ENDOSCOPE-ASSISTED MICROSURGICAL RESECTION OF CPA EPIDERMOIDS
Henry W Schroeder, MD; Mariam A Al Mutawa, MD; Viktoria Bogaczyk, MD; Ehab El Refaee, MD; Department of Neurosurgery, University Medicine Greifswald
Objective: To determine the value of endoscope assistance in the microsurgical resection of CPA epidermoids.
Methods: 26 patients harboring an epidermoid in the CPA were treated using an endoscope-assisted microsurgical technique. In two patients, two surgeries were performed because of the tumor extension. In all cases, most of the tumor mass was removed under microscopic view. Tumor parts which were not visible with the microscope were removed under endoscopic view of 30° and 45° endoscopes.
Results: In 20 of the 26 surgeries (77 %), tumor remnants which were not visible with the microscope were identified with the endoscope and resected under endoscopic view. The endoscope was especially helpful when the tumor extended into another cranial compartment. The tumor was completely evacuated in 21 patients (81 %). In 5 patients, a near total resection (less than 5 % tumor) was identified on the postop MR images. In 6 patients, the cyst membrane was totally removed. In most patients, however, small parts of the capsule which were adherent to nerves and vessels were left in place. There was no obvious complication related to the application of the endoscope. There was no mortality. Temporary deficits included hearing loss, abducens, facial, and lower cranial nerve palsy. Hoarseness and dizziness loss remained permanent in one patient each.
Conclusion: The endoscope-assisted microsurgical technique enhances the radicality of the tumor resection while decreasing the amount of skull base drilling and retraction which is necessary to expose the tumor. It enables a safe tumor removal even when tumor parts are not visible in a straight line. In epidermoids with tumor parts extending into Meckel’s cave or the middle cranial fossa, a simple retrosigmoid craniotomy was sufficient to remove the lesion.