title: Endoscope-Assisted Microsurgical Subtemporal Keyhole Approach to the Posterolateral Suprasellar Region and Basal Cisterns.
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.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rehder
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. Electronic address: Alan.Cohen@jhmi.edu.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Cohen
mesh_terms: D001921:Brain / Q000601:surgery*; D002102:Cadaver; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*
keywords: Anatomy; Endoscope-assisted microsurgery; Minimally invasive neurosurgery; Operative technique; Subtemporal keyhole approach; Suprasellar region