A New Powered Endoscope Holding Arm for Endoscopic Surgery of the Cranial Base

Abstract

Over the past 20 years endoscopy has become an essential part of nearly all surgical specialities. In the field of skull base surgery recent articles describe new applications and highlight improved results in pituitary adenoma removal, vascular decompression surgery, and in the resection of many other skull base tumors. The strength of the endoscope in skull base surgery lies in its ability to see behind bony apices and neurovascular structures, which normally obscure the view of the operating microscope. Paramount to the success of the endoscope in skull base and pituitary surgery is the ability to secure the arm in position. Operating in the confined spaces of the skull, the instability and difficult adjustment of currently available endoscope holding arms is cumbersome for the surgeon and dangerous to the patient. Many surgeons have commented that the currently available endoscope holding arms are inadequate for contemporary applications of endoscopic skull base surgery. In this article we describe a new pneumatically powered endoscope holding arm, which provides the level of stability and ease of adjustment necessary for current and future applications of endoscope skull base surgery.

Endoscopy - Endoscoping Holding Arm - Skull Base Surgery - Minimally Invasive Surgery

References

• 1 Doyen E. Surgical therapeutics and operative techniques. In: Balliere, Tindall, Cox, eds. London 1917: 599-602
• 2 Kern E B, Pearson B W, McDonald T J, Laws E R. The transseptal approach to lesions of the pituitary and parasellar regions.  Laryngoscope. 1979;  89 (5 Pt 2 Suppl 15) 1-34
• 3 Kern E B. Grand rounds: transnasal pituitary surgery.  Arch Otolaryngol. 1981;  107 (3) 183-190
• 4 Jankowski R, Auque J, Simon C, Marchal J C, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery.  Laryngoscope. 1992;  102 198-202
• 5 O'Donoghue G M, O'Flynn P. Endoscopic anatomy of the cerebellopontine angle.  Am J Otol. 1993;  14 122-125
• 6 Gamea A, Fathi M, el-Guindy A. The use of the rigid endoscope in trans-sphenoidal pituitary surgery.  J Laryngol Otol. 1994;  108 19-22
• 7 Magnan J, Chays A, Lepetre C, Pencroffi E, Locatelli P. Surgical perspectives of endoscopy of the cerebellopontine angle.  Am J Otol. 1994;  15 366-370
• 8 Heilman C B, Shucart W A, Rebeiz E E. Endoscopic sphenoidotomy approach to the sella.  Neurosurgery. 1997;  41 602-607
• 9 Magnan J, Caces F, Locatelli P, Chays A. Hemifacial spasm: endoscopic vascular decompression.  Otolaryngol Head Neck Surg. 1997;  117 308-314
• 10 Jennings C R, O'Donoghue G M. Posterior fossa endoscopy ⟨editorial⟩.  J Laryngol Otol. 1998;  112 227-229
• 11 Magnan J, Sanna M. Endoscopy in neuro-otology. New York: Thieme 1999
• 12 Jarrahy R, Berci G, Shahinian H K. Assessment of the efficiacy of endoscopy in pituitary adenoma resection.  Archives of Otolaryngology. 2000;  126 1487-1490
• 13 Miller A J, Amedee R G. Functional anatomy of the paranasal sinuses.  J La State Med Soc. 1997;  149 85-90
• 14 Helal M Z. Combined micro-endoscopic trans-sphenoid excisions of pituitary macroadenomas.  Eur Arch Otorhinolaryngol. 1995;  252 186-189
• 15 Jarrahy R, Young J, Berci G, Shahinian H K. Endoscopic skull base surgery I: a new animal model for pituitary surgery.  J Invest Surg. 1999;  12 289-294
• 16 Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS).  Minim Invasive Neurosurg. 1998;  41 66-73
• 17 Jho H D. Endoscopic Pituitary Surgery.  Pituitary. 1999;  2 139-154
• 18 Jho H D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients.  J Neurosurg. 1997;  87 44-51
• 19 Jho H D, Carrau R L, Ko Y, Daly M A. Endoscopic pituitary surgery: an early experience.  Surg Neurol. 1997;  47 213-222; discussion 222 - 223
• 20 Jarrahy R, Cha S, Berci G, Shahinian H K. Endoscopic transglabellar approach to the anterior fossa and paranasal sinuses.  J Craniofac Surg. 2000;  11 412-417
• 21 Jarrahy R, Cha S, Berci G, Shahinian H K. Fully endoscopic vascular decompression of the trigeminal nerve.  Minim Invas Neurosurg. 2002;  45 32-35
• 22 Jarrahy R, Cha S, Berci G, Shahinian H K. Fully Endoscopic vascular decompression of the glossopharyngeal nerve.  J Craniofac Surg. 2002;  13 (1) 90-95
• 23 Jarrahy R, Berci G, Shahinian H K. Endoscope-assisted microvascular decompression of the trigeminal nerve.  Otolaryngol Head Neck Surg. 2000;  123 218-223
• 24 Eby J, Cha S, Shahinian H K. Fully endoscopic vascular decompression of the facial nerve.  Submitted - Skull Base Surgery. 2001;  11 189-196
• 25 Koren I, Hadar T, Rappaport Z H, Yaniv E. Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: endonasal complications.  Laryngoscope. 1999;  109 1838-1840
• 26 Yaniv E, Rappaport Z H. Endoscopic transseptal transsphenoidal surgery for pituitary tumors.  Neurosurgery. 1997;  40 944-946
• 27 Jarrahy R, Suh R, Berci G, Shahinian H K. Endoscopic pituitary surgery: an in vivo model for transnasal transsphenoidal hypophysectomy.  J Laparoendosc Adv Surg Tech A. 1999;  9 211-219
• 28 Jarrahy R, Shahinian H K, Young J, Berci G. Endoscopic skull base surgery II: a new animal model for surgery of the posterior fossa.  J Invest Surg. 1999;  12 335-339