The Endoscopic Approach to the Posterolateral Skull Base

Objective: The endoscopic approach to the posterolateral skull base is a minimally invasive technique that allows an alternative to the traditional open retrosigmoid craniotomy for various pathologies encountered in this region. Use of a purely endoscopic approach provides superior visualization of the contents of the cerebellopontine angle (CPA) and posterior fossa contents while limiting retraction on the cerebellum. Our objective is to outline the patient selection, necessary preparation, specialized equipment, and surgical technique used to maximize the effectiveness of using this approach.

Methods: Over the last 28 months, 47 patients have been operated on for various pathologies involving the CPA, including cranial nerve decompression, tumor resection, and vestibular neurectomy. We retrospectively reviewed the 47 procedures on patients who underwent purely endoscopic procedures of the CPA and carefully documented the specific criteria for patient selection, presurgical preparation, intraoperative monitoring, and surgical technique to help standardize the procedure.

Conclusion: Endoscopic techniques are becoming increasingly used throughout the world as alternatives to traditional open approaches. By using the endoscope to gain access to the posterolateral skull base, one can achieve improved visualization of the CPA contents and various pathologies that may be encountered in this region. Although endoscopic techniques in this region are in there infancy, we have shown that when certain criteria are followed, specifically related to patient selection and surgical technique, the usefulness of a purely endoscopic technique can be fully realized.