An Electrophysiological Study on the Safety of the Endoscope-assisted Microsurgical Removal of Vestibular Schwannomas

Background: Endoscopy is being increasingly used in skull base surgery. The issue of its safety, however, has not been definitely solved.

Methods: We evaluated the risk of thermal or mechanical iatrogenic nerve injury related to endoscope application during microsurgical removal of vestibular schwannomas (VS) in a prospective group of 30 patients (Group A). Main analysed parameters were electrophysiological monitoring data (auditory evoked potentials and EMG) during and after endoscopic observation. The structural and functional preservation of facial and cochlear nerves, radicality of tumour removal, and CSF leak rate were evaluated and compared to historical group of 50 patients (Group B), operated consecutively with classical microsurgical technique.

Results: No electrophysiological changes directly related to endoscope were registered. The rate of loss of waves I, II, and V did not depend on application of endoscope and was similar in both groups. The functional and general outcome was also similar. Endoscopic inspection provided early and detailed view of anatomical relations within cerebellopontine angle and internal auditory canal and confirmed completeness of tumour removal. Total tumour removal was achieved in all patients from Group A and in 49/50 from Group B. Useful hearing after the surgery had 17/30 patients in Group A and 26/50 in Group B.

Conclusions: The application of endoscope during microsurgical removal of VS is a safe procedure that does not lead to heat-related or mechanical neural or vascular injuries. The actual significance of this additional endoscopic information, however, is related to the particular operative technique and experience of the surgeon.