Anatomical Study
A comparative study of endoscopy and microscopy in exposure of posterior fossa through the intradural subtemporal keyhole approach
Zhemin Ding, Qing Wang, Xiaojie Lu, Bing Li, Xinwei Qian
Published 2019-12-28
Cite as Chin J Neurosurg, 2019, 35(12): 1266-1270. DOI: 10.3760/cma.j.issn.1001-2346.2019.12.017
Abstract
ObjectiveTo comparatively analyze the differences between endoscopy and microscopy in area of exposure and surgical freedom in posterior fossa through the intradural subtemporal keyhole approach and to explore the advantages of neuronavigation in that approach.
MethodsTwenty endoscopic intradural subtemporal keyhole approaches (EISKA) were performed on 10 cadaveric adult heads. An intradural Kawase approach and a navigation-assisted intradural Kawase approach were then carried out on a random side of each specimen. Related anatomic structures were observed through endoscope and microscope at the end of each approach. Anatomic exposure and surgical freedom were measured by transparent graph paper and were analyzed.
ResultsCompared with microscopy, the superior, inferior and medial limits through endoscopic exposure were increased by 2.9±1.0 mm, 15.7±1.5 mm and 10.2±1.1 mm, and the surgical freedom was increased by 2.9±1.0 mm, 7.6±1.9 mm and 6.0±1.7 mm (P<0.05) in the intradural subtemporal keyhole approach. In intradural Kawase approach, the anatomic exposure was increased by 2.7±0.9 mm, 20±1.2 mm and 29.5±0.7 mm and the surgical freedom was increased by 2.7±0.9 mm, 14.8±1.4 mm and 8.8±1.4 mm (all P<0.05). In navigation-assisted intradural Kawase approach, the anatomic exposure was increased by 3.1±1.0 mm, 20.3±2.4 mm and 29.9±0.7 mm, and the surgical freedom was increased by 3.1±1.0 mm, 15.3±1.6 mm and 8.8±1.3 mm (P<0.05). Using a frameless navigational device, the inferior limit of the anatomic exposure was increased by 3.8±2.2 mm in endoscopy and 3.5±0.7 mm in microscopy, and the surgical freedom was increased by 2.7±0.9 mm in endoscopy mm and 2.2±1.2 mm in microscopy (all P<0.05).
ConclusionsThe EISKA could provide more anatomic exposure and surgical freedom mainly in the superior, inferior and medial directions of the brainstem regions. More inferior anatomic exposure and surgical freedom of the posterior cranial fossa could be obtained by navigational assistance.
Key words:
Natural orifice endoscopic surgery; Microsurgery; Neuronavigation; Subtemporal approach; Key hole; Kawase approach
Contributor Information
Zhemin Ding
Department of Neurosurgery, the Affiliated Hospital of Jiangnan University (the Fourth People′s Hospital of Wuxi), Wuxi 214062, China
Qing Wang
Department of Neurosurgery, Wuxi Second People′s Hospital Affiliated Nanjing Medical University, Wuxi 214000, China
Xiaojie Lu
Department of Neurosurgery, Wuxi Second People′s Hospital Affiliated Nanjing Medical University, Wuxi 214000, China
Neuroscience Center, Jiangnan University, Wuxi 214062, China
Bing Li
Department of Neurosurgery, Wuxi Second People′s Hospital Affiliated Nanjing Medical University, Wuxi 214000, China
Xinwei Qian
Department of Neurosurgery, the Affiliated Hospital of Jiangnan University (the Fourth People′s Hospital of Wuxi), Wuxi 214062, China
