• Oreste de Divitiis, Luigi M Cavallo, Mateus Dal Fabbro, Andrea Elefante, and Paolo Cappabianca.
• Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. dediviti@unina.it
• Neurosurgery. 2007 Nov 1; 61 (5 Suppl 2): E239-40; discussion E240.

ObjectiveIn the last 10 years, experience with endoscopic transsphenoidal surgery for the treatment of sellar and perisellar lesions has highlighted advantages brought about by the endoscope for less-invasive procedures. Focusing on these advantages, there is increasing interest in endoscope use for treatment of lesions located in other regions such as the cerebellopontine angle (CPA). Epidermoid tumors, especially those located on the CPA, resulting from their avascular and noninfiltrative nature, appear particularly suited to being treated using an endoscopic approach.Clinical PresentationA 37-year-old man with a 2-year history of left trigeminal neuralgia responded poorly to medical therapy. Magnetic resonance imaging scans revealed a left CPA lesion compatible with an epidermoid tumor, and he was admitted for surgical treatment.TechniqueWe report a patient who underwent freehand dynamic endoscopic resection of an epidermoid tumor of the CPA. This technique requires two surgeons to work in close cooperation: the "navigator," who holds the endoscope and makes fine position adjustments, and the "pilot," who uses both hands to perform the procedure itself under dynamic endoscopic view.ConclusionThe patient's postoperative course was uneventful. The trigeminal neuralgia completely resolved, and postoperative control magnetic resonance imaging scans demonstrated no residual lesion. The benefits of endoscopic treatment for CPA lesions, with special emphasis on the dynamic aspect of this new technique, are discussed.

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