Endoscopic vestibular schwannoma surgery.

In the last few decades, the role of the endoscope in the treatment of middle ear pathology has become increasingly popular. Through experience gained in endoscopic anterior skull-base surgery, developed using the nose as a surgical corridor, approaches to the inner ear and the lateral skull base have changed as well. Recently, Marchioni et al. have developed a new minimally invasive approach to reach structures beyond the middle ear, using the external auditory canal as a natural corridor and the medial wall of the tympanic cavity as a surgical window. Therefore, the transcanal transpromontorial approach, an exclusively endoscopic technique, has become a viable option to surgically manage vestibular schwannomas. Although this approach is reserved for a limited number of well-selected patients, it is characterized by lower intra- and perioperative morbidity, if compared to more traditional approaches, and by a shorter hospital stay. In addition to the exclusively endoscopic technique, the endoscope is a useful adjunct to traditional surgical approaches to the lateral skull base and inner ear. In fact, taking advantage of the magnification offered by this tool, endoscopic-assisted procedures allow for better visualization of the surgical field, especially during the final check, to evaluate the radicality of the surgical resection.