The Role of neuroendoscopy in acoustic neuroma surgery

Objective To explore the role of neuroendoscopy in acoustic neuroma surgery.Methods We used electrophysiological monitoring and audiometry test to evaluate risk of thermal and mechanical iatrogenic injuries during neuroedoscopic removal of acoustic neuroma.We evaluated the role of neuroendoscopy in the structural and functional preservation of facial and cochlear nerve,radicality of tumor removal,and cerebrospinal fluid leakage rate.Results Neuro-electrophysiological changes were not monitored during neuroendoscopic surgery.The rate of loss of waves Ⅰ,Ⅱ,and Ⅴ is not associated with neuroendoscopic application,neuroendoscopic surgery provided early and detail view of anatomical relation within internal auditory canal,and confirmed completeness of radicality of tumor removal in the canal.Among the 16 patients,total tumor removal was achieved in 15 patients,and subtotal in 1 patient.The facial nerve was preserved anatomically in 16 cases,H-B Grade Ⅰ～Ⅱ in 8 patients,Grade Ⅲ～Ⅳ in 5 patients,Grade Ⅴ～Ⅵ in 3 patients.After the surgery 3 patients had useful hearing.There is no leakage of cerebrospinal fluid.Conclusions Neuroendoscopy could provide early and detail view of anatomical relation within internal auditory canal,and determine if the tumor is residual,and cerebrospinal fluid leakage,and clearly reveal a more detailed relationship between acoustic neuroma and the nerves of facial and cochlear.Application of neuroendoscopy in acoustic neuroma surgery does not lead to thermal and mechanical iatrogenic nerves and blood vessels damage.Effect of neuroendoscopic surgery is closely related with endoscopic technology and experience of the neurosurgeon. Key words: Acoustic neuroma; Neuroendoscopy; Electrophysiologic monitoring; Hearing preservation; Facial nerve preservation