Comparison of Microscopic and Endoscopic Approaches to the Cerebellopontine Angle

ObjectiveTo examine the efficacy of the endoscope as an adjunct to the operating microscope in defining the surgical anatomy of the cerebellopontine angle (CPA).MethodsThe surgical anatomy of the CPA was examined in cadaveric CPAs through a retrosigmoid approach. The upper, middle, and lower neurovascular complexes and the individual segments of the cerebellar arteries in the CPA were examined with the surgical microscope and 0° and 45° rigid endoscopes.ResultsThe microscope provided satisfactory views of the posterior surface of the neural and vascular structures in the central part of the CPA cistern. The endoscope provided superior views of the nerves' junction with the brainstem, their dural exit, and their vascular relationships. The endoscope also provided superior views of the individual segments of the cerebellar arteries.ConclusionThe combination of endoscopic and microsurgical techniques aids in achieving optimal exposure in CPA surgery.