Combined Exoscopic- and Endoscopic-Assisted Resection of an Interpeduncular and Middle Fossa Epidermoid Cyst via a Transcavernous Approach: Technical Note.

Abstract

The endoscope and exoscope are gaining momentum as alternative visualization tools in the neurosurgical field, trying to overcome the limitations of an operative microscope and support minimally invasive approaches. However, few case series are available in the literature regarding their use in skull base surgery, especially in combined assisted resection, and their usefulness still needs to be proved. An illustrative case to present the feasibility and minimally invasive advantages of a combined exoscopic- and endoscopic-assisted resection is reported. A 22-year-old man presented with a history of seizures and dizziness. Brain imaging showed a lesion involving the anteromedial middle fossa invading the interpeduncular cistern and impinging the brainstem, suggestive of an epidermoid cyst. A combined exoscopic- and endoscopic-assisted resection through a pterional transcavernous approach was planned and performed. No neurologic deficit occurred after the surgery, providing further evidence about the usefulness and safety of this hybrid technique. Combined exoscopic and endoscopic resection is also feasible and safe in complex skull base surgery. Moreover, this technique seems to be effective for minimizing the surgical invasiveness in skull base lesions.