The Use of Endoscope in Retrolabyrinthine Approach for Cerebellopontine Angle Region Surgeries

LI Xiaohua; YANG Jie; ZHU Weidong; CHAI Yongchuan; JIA Huan; WANG Zhaoyan; WU Hao

doi:10.3969/j.issn.1672-2922.2017.04.002

Abstract：Objective To report application of endoscope in the retrolabyrinthine approach of cerebellopontine an-gle surgery. Methods A total of 32 patients undergone endoscopic surgeries for CPA lesions via retrolabytinthine ap-proach from January 2010 to January 2016 were reviewed, including 19 males and 13 females with ages ranging from 25-69 years. Surgery indications included cranial neuropathy (n=27, Meniere's disease n=20, hemifacial spasm n=5 , tri-geminal neuralgia n=2), CPA cholesteatoma (n=3) and vestibular schwannnoma (n=2). Patients were followed up for 1-5 years. Results Symptoms in the 27 cases of cranial neuropathy resolved after surgery. Vestibular neurectomy was performed in the 20 cases of Meniere's disease and the rate of postoperative vertigo control was 100%. Microvascular decompression of the facial nerve was done in the 5 cases of hemifacial spasm with complete remission of facial spasm symptoms after surgery. Trigeminal nerve microvascular decompression in the 2 cases of trigeminal neuralgia also brought symptoms resolution after operation. There were no complications, nor clinical recurrence during the 1-5 years follow-up. Total lesion removal was achieved in all 3 patients with CPA cholesteatoma without facial palsy or other neu-rological deficits. Useful hearing was preserved in two patients, and no matrix recurrence was found during the 1-5 years follow-up. Tumor removal was total without facial palsy or other neurological deficits in the 2 patients with vestib-ular schwannomas, with preservation of useful hearing and no tumor recurrence during the 1-5 years follow-up in both patients. Conclusions Endoscopic assisted retrolabyrinthine approach has good application value in functional cranial nerve surgeries. It provides excellent exposure of the responsible blood vessel and cranial nerves (CN) V-XI. In cerebel-lopontine angle cholesteatoma and acoustic neuroma surgeries, endoscopy can help achieve minimally invasive resec-tion of lesions.