Endoscope-Assisted Microsurgical Approach to the Posterior and Posterolateral Incisural Space

Roberta Rehder, Marcos Perocco Luiz Da Costa, Ossama Al-Mefty, Alan Cohen

Research output: Contribution to journalArticle

Abstract

Objective Despite recent technological advances, direct approaches to the posterolateral incisural space remain surgical challenges. The choice of the operative route depends on the exact location and extent of the target lesion as well as individual preferences. The extreme lateral infratentorial supracerebellar approach to treat pathologies located in the ambient cistern and posterior incisural space is a technically feasible route in selected cases. In this cadaveric study, we demonstrate the benefits of endoscope-assisted microsurgical maneuvers using the extreme lateral supracerebellar infratentorial approach. Methods An endoscope-assisted infratentorial supracerebellar approach was performed in six formalin-fixed cadaveric heads using standard microneurosurgical methods. Dissections were performed in a stepwise fashion, comparing the exposure afforded by the microsurgical route alone to the endoscope-assisted route, using 0- and 30-degree angled lenses. Relationships among the target and the surroundings neurovascular structures were described. Results Endoscope-assisted maneuvers for the extreme lateral supracerebellar approach provide an improved operative view and have the potential to reduce parenchymal trauma and neurovascular injuries. The endoscopic techniques bring the surgeon to the anatomy, enhancing illumination and surgical visualization. Conclusions Direct visualization of the posterior and posterolateral incisural space avoids retraction of the occipital lobe and damage to the deep venous complex. The extreme lateral infratentorial supracerebellar corridor is effective for approaching the posterolateral mesencephalic junction and the posterior incisural space in selected cases. Endoscope-assisted microsurgery can improve visualization and minimize parenchymal retraction, which should enhance surgical control.

Original languageEnglish (US)
Pages (from-to)210-217
Number of pages8
JournalWorld Neurosurgery
Volume91
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Keywords

  • Endoscopy
  • Extreme lateral approach
  • Infratentorial supracerebellar approach
  • Key words Anatomy
  • Microsurgery
  • Posterior incisural space

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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