Endoscope-Assisted Microsurgical Subtemporal Keyhole Approach to the Posterolateral Suprasellar Region and Basal Cisterns.

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Endoscope-Assisted Microsurgical Subtemporal Keyhole Approach to the Posterolateral Suprasellar Region and Basal Cisterns.

World Neurosurg. 2017 Feb 20;:

Authors: Rehder R, Cohen AR

Abstract
BACKGROUND: Refinements in optics and instrumentation have enabled surgeons to approach deep-seated intracranial pathologies with reduced exposure and brain retraction. The anterior subtemporal keyhole approach is a minimally invasive route to the posterolateral aspect of the suprasellar area and petroclival region.
OBJECTIVE: In this cadaveric study, we demonstrate the benefits of endoscope-assisted microsurgical techniques in the anterior subtemporal keyhole approach.
METHODS: The anterior subtemporal keyhole approach was performed bilaterally on five formalin-fixed human specimens using standard microneurosurgical methods. Dissections compared the exposure afforded by the microsurgical route to the endoscope-assisted technique, using zero and 30-degree angled rod-lenses. Anatomical relationships among the surgical target and the surrounding neurovascular structures were described.
RESULTS: Endoscope-assisted maneuvers enhanced the operative view afforded by the microscope and helped to minimize parenchymal retraction and neurovascular injury. Endoscope-assisted microsurgery provides a panoramic picture of the surgical target and its surroundings. It enables the operator to see into hidden corners beyond the microsurgical view. The endoscope provides enhanced visualization of the neurovascular structures located in the posterolateral suprasellar region, basal cisterns, upper and mid-clivus and interpeduncular region.
CONCLUSIONS: Endoscope-assisted microsurgery provides a means to approach selected lesions located in the posterolateral suprasellar region, perimesencephalic cisterns and upper and mid-clivus. Operative view can be maximized by introducing the zero and 30-degree angled endoscopes. Minimally invasive techniques help to optimize surgical exposure and lessen parenchymal retraction, thus improving control of the surrounding neurovascular structures.

PMID: 28232212 [PubMed - as supplied by publisher]

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