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

Roberta Rehder, Alan Cohen

Research output: Contribution to journalArticle

Abstract

Background Refinements in optics and instrumentation have enabled surgeons to approach deep-seated intracranial diseases 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 show the benefits of endoscope-assisted microsurgical techniques in the anterior subtemporal keyhole approach. Methods The anterior subtemporal keyhole approach was performed bilaterally on 5 formalin-fixed human specimens using standard microneurosurgical methods. Dissections compared the exposure afforded by the microsurgical route with the endoscope-assisted technique, using 0° and 30° angled rod-lenses. Anatomic 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 clivus and midclivus, and interpeduncular region. Conclusions Endoscope-assisted microsurgery provides a means to approach selected lesions located in the posterolateral suprasellar region, perimesencephalic cisterns, and upper clivus and midclivus. The operative view can be maximized by introducing the 0° and 30° angled endoscopes. Minimally invasive techniques help to optimize surgical exposure and lessen parenchymal retraction, thus improving control of the surrounding neurovascular structures.

Original languageEnglish (US)
Pages (from-to)114-121
Number of pages8
JournalWorld Neurosurgery
Volume103
DOIs
StatePublished - Jul 1 2017

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Endoscopes
Posterior Cranial Fossa
Microsurgery
Formaldehyde
Lenses
Dissection
Wounds and Injuries
Brain

Keywords

  • Anatomy
  • Endoscope-assisted microsurgery
  • Minimally invasive neurosurgery
  • Operative technique
  • Subtemporal keyhole approach
  • Suprasellar region

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Endoscope-Assisted Microsurgical Subtemporal Keyhole Approach to the Posterolateral Suprasellar Region and Basal Cisterns. / Rehder, Roberta; Cohen, Alan.

In: World Neurosurgery, Vol. 103, 01.07.2017, p. 114-121.

Research output: Contribution to journalArticle

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abstract = "Background Refinements in optics and instrumentation have enabled surgeons to approach deep-seated intracranial diseases 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 show the benefits of endoscope-assisted microsurgical techniques in the anterior subtemporal keyhole approach. Methods The anterior subtemporal keyhole approach was performed bilaterally on 5 formalin-fixed human specimens using standard microneurosurgical methods. Dissections compared the exposure afforded by the microsurgical route with the endoscope-assisted technique, using 0° and 30° angled rod-lenses. Anatomic 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 clivus and midclivus, and interpeduncular region. Conclusions Endoscope-assisted microsurgery provides a means to approach selected lesions located in the posterolateral suprasellar region, perimesencephalic cisterns, and upper clivus and midclivus. The operative view can be maximized by introducing the 0° and 30° angled endoscopes. Minimally invasive techniques help to optimize surgical exposure and lessen parenchymal retraction, thus improving control of the surrounding neurovascular structures.",
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