ENDOSCOPICALLY ASSISTED MICRONEUROSURGERY

Technological developments in neuroendoscopy are leading to an expansi on of applications into the realm of microneurosurgical procedures. Th e new dimension that using an endoscope provides requires insight into different neuroanatomical aspects and a new kind of strategy in plann ing a microneurosurgical procedure. To gain some new insights into the se exciting aspects of neurosurgery we have explored the sellar, paras ellar, and posterior fossa regions in 50 fresh anatomical specimens an d used various types of endoscopes to observe the surgically relevant neurotopographical details. We then utilized this experience in 33 cli nical cases during microsurgical approaches for various lesions (poste rior fossa tumors - 12 cases, sellar and parasellar tumors - 8 cases, transsphenoidal procedures for pituitary adenoma - 7 cases, transventr icular procedures - 6 cases). In the laboratory we found that familiar neuroanatomical structures are seen in a completely different aspect from what we are accustomed. Orientation is at times difficult, which requires rehearsal and special handling of the endoscope for complex c linical procedures. We found that certain structures that are hardly n oticed in routine anatomical views become very important when utilizin g the endoscope (i.e., different arachnoid membranes and trabeculae). Importantly, the dimensions of a microsurgical approach can be greatly enlarged with the endoscope, making it possible to look behind struct ures and ''around corners''. We present our findings with respect to i mportant anatomical details relevant to utilizing the endoscope as an adjunct to microneurosurgical procedures and our clinical data. We hav e concluded that the neuroendoscope can be a safe and helpful adjunct in many microneurosurgical procedures.