The Fully Endoscopic Retrosigmoid Approach

Abstract

This chapter discusses the application of the fully endoscopic retrosigmoid approach to access the cerebellopontine angle (CPA) and petroclival and foramen magnum regions for surgical management of tumors such as schwannomas or meningiomas and neurovascular conflicts involving cranial nerves V through XII that occur in this region of the skull base. The limitations to viewing angles imposed on the surgeon by the operating microscope contrasts with the ability for broad panoramic surveys and different angles of view when endoscopes are used. In our experience, the improved exposure of the entire tumor with virtually no cerebellar retraction has reduced the risk of injury to the brainstem and the surrounding cranial nerves, resulted in more complete tumor removal, decreased the time required to access the CPA, allowed rapid recovery of the patients, and resulted in minimal postoperative discomfort. The chapter provides a thorough description of the fully endoscopic retrosigmoid approach, including indications, operating room setup, patient positioning, operative technique, state-of-the-art illustrative cases, potential complications, and ways to avoid these complications (in the authors’ experience).