microscopic technique
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Author(s):  
Sean C. Sheppard ◽  
Marco D. Caversaccio ◽  
Lukas Anschuetz

Abstract Purpose of Review Stapes surgery has been established as the gold standard for surgical treatment of conductive hearing loss in otosclerosis. Excellent outcomes with very low complication rate are reported for this surgery. Recent advances to improve surgical outcome have modified the surgical technique with endoscopes, and recent studies report development of robotical assistance. This article reviews the use of endoscopes and robotical assistance for stapes surgery. Recent Findings While different robotic models have been developed, 2 models for stapes surgery have been used in the clinical setting. These can be used concomitant to an endoscope or microscope. Endoscopes are used on a regular base regarding stapes surgery with similar outcomes as microscopes. Endoscopic stapes surgery shows similar audiological results to microscopic technique with an advantage of less postoperative dysgeusia and pain. Its utility in cases of revision surgery or malformation is emphasized. Summary Endoscopic stapes surgery is used on a regular basis with excellent outcomes similar to the microscopic approach, while reducing surgical morbidity. Robotic technology is increasingly being developed in the experimental setting, and first applications are reported in its clinical use.


Author(s):  
Andrej Paľa ◽  
Gwendolin Etzrodt-Walter ◽  
Georg Karpel-Massler ◽  
Maria Teresa Pedro ◽  
Benjamin Mayer ◽  
...  

Abstract Introduction Intraoperative magnetic resonance imaging (iMRI) improves the intraoperative detection of adenoma remnants in transsphenoidal surgery. iMRI might be redundant in endoscopic pituitary surgery in non-invasive tumors (Knosp 0–2) due to a superior visualization of anatomical structures in the periphery of the sella turcica compared to the microscopic technique. We identified the anatomical location of tumor remnants in iMRI and evaluated risk factors for secondary resection after iMRI and hereby selected patients with pituitary adenomas who may benefit from iMRI-assisted resection. Methods We conducted a retrospective monocenter study of patients who underwent iMRI-assisted transsphenoidal surgical resection of pituitary adenomas at our department between 2012 and 2020. A total number of 190 consecutive iMRI-assisted transsphenoidal surgeries of pituitary adenomas graded as Knosp 0–2 were selected for analysis. Exclusion criteria were missing iMRI availability or pathologies other than adenomas. Of these 190 cases, 46.3% (N = 88) were treated with microscopic, 48.4% (N = 92) with endoscopic, and 5.3% (N = 10) with endoscopic-assisted technique. Volumetric measurement of preoperative, intraoperative, and postoperative tumor extension was performed. Demographic data, tumor characteristics, and MRI features were evaluated. Additionally, analysis of adenoma remnants identified by iMRI was performed. Results An additional resection after iMRI was performed in 16.3% (N = 31). iMRI helped to reach gross total resection (GTR) in 83.9% (26/31) of these cases. False-positive resection was found in 1 patient (0.5%). Multivariable logistic analysis identified tumor volume (OR = 1.2, p = 0.007) recurrence (OR = 11.3, p = 0.002) and microscopic technique (OR = 2.8, p = 0.029) as independent risk factors for additional resection. Simultaneously, the endoscopic technique was significantly associated with GTR as evaluated by iMRI (OR = 2.8, p = 0.011) and postoperative MRI (OR = 5.8, p = 0.027). The detailed analysis of adenoma remnants on iMRI revealed the suprasellar location in a diaphragm fold, penetrating tumor above the diaphragm, or undetected invasion of cavernous sinus as well as in case of microscopic resection tumor location outside the line of sight as the main reasons for incomplete resections. Conclusion Tumor volume, recurrence, and microscopic technique were identified as independent predictors for additional resection in patients with Knosp 0–2 adenomas. iMRI might increase the extent of resection (EOR) safely even after the endoscopic visualization of the sella with very low risk for false-positive findings. Remnants of tumors hidden within the diaphragmic folds, intrathecally, or behind the infiltrated wall of cavernous sinus not recognized on preoperative MRI were the most common findings in iMRI.


2021 ◽  
Author(s):  
Ben G McGahan ◽  
Thiago Albonette-Felicio ◽  
Daniel C Kreatsoulas ◽  
Stephen T Magill ◽  
Douglas A Hardesty ◽  
...  

Abstract BACKGROUND Hemifacial spasm (HFS) is a socially limiting condition leading to decreased quality of life that can be treated with microvascular decompression (MVD). Endoscopy has been described as an adjunct to traditional microscopy for MVD, although the best visualization technique is debated. OBJECTIVE To review the current literature on use of endoscopy in MVD for HFS and to describe the simultaneous microscopic and endoscopic visualization technique along with a video illustration. METHODS Patients who underwent MVD for HFS were retrospectively reviewed from January 2011 to December 2019. The first set of patients in the series were done using traditional endoscopic assisted visualization, followed by a change in technique in the subsequent patients using the simultaneous endoscopic technique. The surgical technique is described as well as illustrated with a video. RESULTS In total, 21 patients underwent 24 MVDs to treat HFS. The simultaneous endoscopic/microscopic technique was used in 48% of cases for visualization. All but one patient had resolution of their symptoms immediately after the procedure. In total, 7 patients had recurrence of HFS, with 4 (17%) resolving spontaneously and 3 (13%) ultimately undergoing redo MVD. Postoperatively 7 patients (29%) had transient complications that all resolved completely. There was no significant difference between the traditional alternating microscopic and endoscopic technique with the simultaneous endoscopic microscopic technique. CONCLUSION Endoscopic assistance during MVD for HFS is beneficial and may be streamlined by using the simultaneous microscope and endoscope visualization technique.


2021 ◽  
Vol 5 (1) ◽  
pp. V7
Author(s):  
Marco Antônio Zanini ◽  
Aderaldo Costa Alves Junior ◽  
Fabio Pires Botta ◽  
Haniel Moraes Serpa Nascimento ◽  
Pedro Tadao Hamamoto Filho

The authors present a case of a 22-year-old male who developed hydrocephalus symptoms related to a giant epidermoid tumor at the pineal region. The surgical approach and technique for a large epidermoid tumor in this area are extensively discussed. A paramedian contralateral supracerebellar infratentorial and transtentorial approach was performed, with the patient in a semisitting position. The tumor was removed using a microscopic technique, and endoscope assistance was used in order to reach the areas unable to be visualized under the microscope. The patient was neurologically intact at his 2-year follow-up, and postoperative MRI showed a significant decrease in the tumoral volume. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2128.


2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Marianna Török ◽  
Petra Merkely ◽  
Anna Monori-Kiss ◽  
Eszter Mária Horváth ◽  
Réka Eszter Sziva ◽  
...  

Author(s):  
Lihua Wu ◽  
Qinghua Liu ◽  
Bo Gao ◽  
Shaopeng Huang ◽  
Ning Yang

Objectives: To compare the endoscopic approach to manage attic cholesteatoma with conventional microscopic technique. Design: Randomized controlled trial. Participants: A total of 190 patients (192 ears) diagnosed with attic cholesteatoma extending to the antrum area (stages Ib and II) were randomly assigned into two groups: one undergoing endoscopic approach and the other undergoing the microscopic technique. Main outcome measures: The two groups were compared in terms of preoperative and intraoperative findings, access to hidden areas expressed in terms of the Middle Ear Structural Visibility Index (MESVI), mean operative time, and postoperative findings. Results: No difference in the parameters of the preoperative and intraoperative findings analyzed (patient age, computed tomography findings, disease stage, and intraoperative cholesteatoma characteristics) was observed between the endoscopic and microscopic groups. The median MESVI for the endoscopic group was better than that for the microscopic group (P<0.05). The mean operating time using the endoscopic approach was less than that using the microscopic approach (P<0.05). The median postoperative pain score in the endoscopic group was lower than that in the microscopic group (P<0.05). No significant difference was found between the two groups in terms of taste sensation, air-bone gap closure at the end of 4 weeks, and vertigo experienced at the end of the first week. When long-term surgical outcomes were assessed 1 year postoperatively, five patients in the microscopic group had recurrence, four had cartilage displacement, three had perforation, and five had retraction pocket formation. In the endoscopic group, four patients had disease recurrence, three had cartilage displacement, two had perforation, and four had retraction pocket formation. Conclusion: Endoscopic management of limited attic cholesteatoma showed definite advantages over the conventional microscopic approach, such as providing better visualization, requiring less postoperative time, subjecting the patients to less pain, and decreasing the incidence of complications.


2021 ◽  
pp. 1-5
Author(s):  
Hung-Chun Tsao ◽  
Yi-Feng Liao ◽  
Feby Wijaya Pratiwi ◽  
Chung-Yuan Mou ◽  
Yi-Jhen Lin ◽  
...  

Abstract


2020 ◽  
Vol VI (1) ◽  
pp. 190
Author(s):  
B. Vorotynskiy

The translation of Dr. Mercier's book is fully justified by the absence in Russian of such a manual, which is devoted to a detailed description of the complex microscopic technique in the study of the central nervous system. Such an essay, in which the most detailed information is collected and all the necessary indications related to the study of the nervous system are collected, seems to be very useful to have at hand for everyone involved in the microscopic anatomy of the brain, and for those who are just starting out, all such guidance is directly necessary, since they details concerning microscopic techniques, from the description and application of the related instruments to the manufacture and processing of the medium. If we keep in mind some of the important features of microscopic technique in the study of the central nervous system and if we take into account all the difficulty and complexity of this study, then it will become even more clear how such a guide is necessary for beginners.


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