Robert Reisch

Improvements in image guidance, endoscopy, and instruments, have significantly advanced “keyhole” neurosurgery. We describe the concept and technique of the supraorbital keyhole approach.

Little is known on the long-term course of patients treated for intracranial solitary fibrous tumors (iSFT). We therefore retrospectively reviewed the charts of our patients who underwent Gamma Knife radiosurgery (GKRS) for iSFT at Klinik Im Park in Zurich and who were treated by one of the authors. Between 1994 and 2009, two patients underwent GKRS for iSFT at Klinik Im Park. One patient underwent altogether five radiosurgical treatments and two craniotomies for iSFT and its local recurrences. The other patient underwent two craniotomies and one radiosurgical treatment for iSFT. Both patients maintained a Karnofsky performance score 100 during follow-up and both were long-term survivors with a follow-up of 9 and 17 years, respectively. A close follow-up of patients with iSFT and repeat radiosurgery or surgery when indicated seems to lead to a favorable long-term outcome.

Objective: The concept and surgical technique of endoscope-assisted keyhole surgery in treating lesions of the anterior fossa and central skull base is described in this article.

Lack of stereoscopy and inferior image resolution prevented endoscopes to become standard in Neurosurgery. The new Einstein Vision^® system provides a 3D HD non-distorted image. The objective is to evaluate image quality and suitability for neurosurgery. The Einstein Vision^® system was used for nine operations including four meningiomas, two aneurysms, one intraspinal lipoma, one lumbar stenosis, and one neuroma of the sciatic nerve. Image quality and suitability were analyzed in a semi-quantitative manner based on each 10 aspects and compared to an operating microscope. The system was successfully used in eight operations. Two operations could be completed with the new system as the only optical tool. In six operations it could be used only for certain parts, and in one operation the 3D effect was significantly disturbed. Overall, the image quality was rated “equal” to the microscope. Two aspects were found to be superior, four aspects equal, and four aspects inferior. Suitability was rated overall as “inadequate”. No aspect was rated superior, two aspects equal, six aspects inferior and two aspects could not be rated. Presently, image quality was found to be equal to the operating microscope but suitability for minimal invasive neurosurgical operation is inadequate.