Role of the Neuroendoscope for Microscopic Surgery : Effective Use in the Proper Situation(<SPECIAL ISSUE>Progress in Neuroendoscopy)

Ono Shigeki, Ishida Joji, Yasuhara Takao, Kurozumi Kazuhiko, Ichikawa Tomotsugu, Date Isao

doi:10.7887/jcns.20.716

The microscope has been a major surgical tool in the field of neurosurgery since the 1970's. On the other hand, the neuroendoscope has recently begun playing not only a supporting role for microscopic surgery in several types of skull base surgery, transsphenoidal surgery, or intraventricular manipulation, but also been used in many other operative scenes. Meanwhile, because the simultaneous usage of microscope and endoscope is differently handled from institution to institution, there is no regular instruction on how to best use the neuroendoscope for microscopic surgery at the present moment. In this background, we feel impelled to consider how to use the endoscope for microscopic surgery, and how the relation between microscope and endoscope should develop. Therefore, in this paper, we analyzed the indications for endoscopic surgery, how to use the endoscope in different neurosurgical scenes, and to what extent the endoscope is used in our institution. Since we introduced the EndoArm (Olympus, Japan) from 2004 in our institute, endoscopic usage has accounted for a larger share of skull base surgery, year by year. As we have employed the single use of the endoscope for transsphenoidal surgery since last year, the frequency of endoscopic usage has dramatically increased, and the endoscope has replaced the microscope in this procedure. In the meantime, the microscepe still plays an important role in the endonasal procedures of transsphenoidal surgery due to its 3 dimensional view, hemostasis, ease to insert several devices, and its high resolution. In skull base surgery, the endoscope was particulary useful in wide-open areas, such as the anterior skull base in which a rigid endoscope can be inserted freely. The endoscope was also frequently used even in cases of exploration and repair of cerebrospinal fluid leakage in the frontal skull base, and removal of the interosseus chordoma in the skull base in the blind corner of the microscope field. In conclusion, the microscope is still an important tool for understanding 3 dimensional conformation or obtaining hemostasis in difficult bleeding cases for the endoscope. Both the microscope and endoscope are now developing rapidly these days, and the relation between microscope and endoscope is also changing based on these developments. Thus, we should try to raise both the microscope and endoscope to a higher dimension with considerations to compensate for the shortcomings of each.

Role of the Neuroendoscope for Microscopic Surgery : Effective Use in the Proper Situation(<SPECIAL ISSUE>Progress in Neuroendoscopy)

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