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Objective To compare lateral orbital keyhole approach(LOK) with conventional keyhole approach including supraorbital keyhole approach (SOK) and pterional approach(PTK) for exposuring the sellar region and oper-ation ability, to provide theoretical and practical basis for the clinic. Methods From January, 2017 to Feburary, 2018, 15 cadaver head specimens of Chinese (30 sides) fixed by formalin were randomly divided into 3 groups, simu-lating SOK, LOK and PTK, application of frameless neuronavigation system, intersection of the posterior margin of the optic chiasma and the lamina terminalis served as the base point. Six different reference points were selected to radi-ate into the parasellar region of the skull base. The direction of the 2 adjacent reference points were connected to the base point to form a triangle. Six triangles constituted the sellar region to represent the total area. The supratentorial area, ipsilateral area, inferior area and contralateral area were calculated by stacking triangle. The comparison was made between groups. The Salma operation exposure scale was used to simulate the aneurysms of the common parts in the brain and the quantitative scores were performed. Results The total parasellar regions by SOK, LOK and PTK respectively were:(1641.6±295.6)mm2, (1782.3±294.6)mm2 and (1552.5±307.4)mm2. There was no statistical differ-ence(P>0.05); To compare the supratentorial region, SOK and LOK were both bigger than PTK ( P<0.05); To compare the ipsilateral and infratentorial area, LOK and PTK were both bigger than SOK respectively ( P<0.05);To compare the contralateral area, SOK, LOK and PTK were increased in turn (P<0.05). Salma operation exposure scale was used to get the scores:the score of SOK was 29.7 (39.08％), LOK was 37.0 (48.68％), and PTK was 36.1 (47.50％). Conclusion Anatomical analysis displayed that the 3 keyhole approaches showed different exposure of each part the parasellar re-gions, the LOK had a good exposure to the parasellar region and so as the higher maneuverability. But the clinical appli-cation should be comprehensive analysis, pay attention to specific lesions and make an appropriate choice. It has impor-tant clinical significance to improve the prognosis of patients.
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Objective To study the anatomical features and operative significance of ophthalmic segment of internal carotid artery by the lateral orbital keyhole approach .Methods Selected 15 cases (30 sides) adult cadavers with formalin perfusion including 2 fresh cadavers perfused with red and blue latex and simulated by lateral orbital keyhole craniotomy .Surgical microscope was used to observe the morphologi-cal characteristics ,adjacent relaionship and important perforating vessels of the ophthalmic artery segment of internal carotid artery .The data measured after the brain was removed from the brain .Results The ophthalmic segment of internal carotid artery originated from the distal dura ring of upper cavernous sinus sphenoidalis and ended at the initial side of posterior communicating artery .The anterior half segment was blocked by the anterior process and the optic nerve and sent out fibrous structures to wrap the surrounding tissue .The starting point of oph-thalmic artery located at 5 mm of anterior end of the anterior process in 28 sides (82.4％),5 mm of the medial aspect of the anterior process in 22 sides (64.7％).The superior hypophyseal artery (SHA) could send 2 to 3 grades of perforating vessels to supply the anterior optic nerve,optic chiasma and pituitary stalk .Conclusion When we treat sellar region lesions by the lateral orbital keyhole approach ,especially for clipping the aneurysm at the ophthalmic segment ,we should expertly master the anatomical features of ophthalmic segment of internal ca -rotid artery,focus on protecting these perforating vessels ,and it has important clinical significance for the prognosis of the patients .
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Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.
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Objective To explore the effect of neuroendoscopic surgery for the removal of medium and large sized tuberculum sellae meningiomas through supraorbital keyhole approach.Methods A retrospective research was performed on 7 case of patients with tuberculum sellae meningioma who underwent endoscopic surgery through supraorbital keyhole approach.The main performance of patients as tumor diameter were 2.8-4.7 cm and the skin incision located at superciliary aich which size of intra-frontal bone window was 3.5 cm× 2.0 cm.Results Total removal was achieved in 7 cases(simpson Ⅰ grade in 2 patients,sirnpson 1Ⅱ grade in 5 patients).Postoperative,the visual outcomes of eyes were showed improvement in 9 eyes,remained steady in 3 eyes,and deterioration in 2 eyes.All patients were followed up for 6-13 months and no recurrence was found.Conclusion Neuroendoscopic surgery through supraorbital keyhole approach is an effective method for the resection of medium and large sized tuberculum sellae meningiomas.
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Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.
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Objective:With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques,it is necessary to re-examine the therapeutic strategy for the treat-ment of petroclival meningiomas.To sum up the operative experience and methods in microsurgical resec-tion of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach.To explore the minimally invasive operation approach of petroclival meningiomas,to raise the removal degree and to improve the postoperative result using this approach.Methods:The clinical data of the consecutive 21 patients with the petroclival meningiomas were reviewed retrospectively.The meth-od,degree of tumor resection,techniques of the combining keyhole approach,Karnofsky performance score (KPS)before and after operation were also analyzed.The neuronavigation guided operation was performed in 9 cases,and 12 cases were operated in the neuroelectrophysiological monitoring.Results:Total excision of the tumor resection (Simpson,Ⅰ -Ⅱlevels)was conducted in 18 cases (85.7%,18 /21),and 3 patients underwent close resection (Simpson Ⅲ level,14.3%,3 /21).Postoperative three-dimensional CT showed good lock bone flap restoration;Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases (23.8%),including transient trochlear nerve (3 cases),abducent nerve (1 case),and the motor branch of trigeminal nerve paralysis (1 case).Abducent nerve paralysis (1 case)appeared,with hearing impairment.After the 3-month follow-up,11 cases had the same KPS aspreoperation,7 cases improved,and 3 cases not improved.The KPS score was 77.14 ±23.12 on average,and there was no statistically significant difference compared with that before operation (P >0.05 ).The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases (KPS 70 or higher),and general recovery in 2 cases (KPS <70).The postoperative follow-up for 3 -29 months showed no tumor recur-rence or progress.Conclusion:The combining trans-subtemporal and suboccipital retrosigmoid keyhole approach is simple,safe,and minimally invasive,and an ideal operation approach of petroclival menin-gioma.To master the operation skills and the intraoperative matters needing attention in the operation,is favorable to improve the resection rate and curative effect.
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Objective To investigate the clinical application and surgical techniques of lateral-orbital keyhole approach to clip ruptured tiny aneurysms.Methods A retrospective analysis was performed on the clinical data of 56 patients with ruptured tiny aneurysms, including examination methods, imaging features, diagnosis and treatment process, and operation effect, which underwent lateral-orbital keyhole approach from January 2013 to April 2014.Results Among 56 patients with a total of 61 aneurysms(56 tiny aneurysms) was examined by CT angiography (CTA) and/or digital stubtraction angiography (DSA), all achieved successful clipping with a rupture rate of 16％(13 cases).Forty-two cases got a good recovery,8 cases owned the self-care ability, and 6 cases could carry out daily lives with help.There was no rebleeding and mortality, according to a 2-28 months' follow-up of 49 patients.Conclusion As a surgical approach for Willi'S cycle aneurysm,the lateralorbital approach is simple,rapid,minimally-invasive way.It is available in the clipping of ruptured tiny anterior communicating aneurysms.The option of operative time, perfect microdissection and exquisite intraoperative microinvasive operative skills, will be the key point of clipping aneurysms, preventing and controlling of intraoperative bleeding.
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IntroductionA cerebral aneurysm has been surgically treated since the early twentieth century. Since then, numerous new surgical methods and technologies have been developed in neurosurgical practice to improve outcome of the neurosurgical treatments. In fall of 1980, the very first aneurysm surgery was successfully performed in Mongolia. Until 2011, the bitemporal and pterional approaches had been used as the main treatment option for anterior circulation aneurysms in Mongolian neurosurgicalpractice. The keyhole approach, cultivated by German neurosurgeon A.Perneczky, was introduced to Mongolian neurosurgical practice in 2011 as another threatment option for the anterior circulation aneurysmGoalThis study aimed to design new key hole surgical techniques with four small burr holes, based on the method of German neurosurgeon A. Perneczky for treatment of anterior circulation aneurysms and decrease the rate of surgically related complications.Materials and MethodsBetween January 2011 and March 2012, in the neurosurgical department of Third State Central Hospital 259 patients were treated with anterior circulation aneurysms. 103 of them treated with key hole approaches (as the study groupe), while 55 were treated with pterional approaches. We choose 103 patients reports (as the control groupe), who were treated with traditional approaches and studied the results retrospectively, which were compared with the results of the new techniquesof surgical treatment. We compared the outcomes of the new keyhole surgical approach with the outcomes of traditional approaches based on the severity of after surgery complications, focal neurological deficits, postoperative mental changes and functional impairments, and duration of hospital stay (recovery period). The skin incision begins laterally from the supraorbital incisura and is made within the eyebrow. Posterior to the temporal line at the level just above the zygomatic arch we drilled two small (0.5 cm) burr holes, and two more burr holes above the orbital rim. Quadrangle shaped bone flap is cut with the angle 45o, and removed, after which drill of the inner edge of the bone above the orbital rim. Inner edge of the other side is not drilled off. After intradural procedure, we fixed bone flap using the inner edge, which was not drilled off.ResultsFrom Jan, 2011 to Dec, 2012, 235 patients received surgical treatment (78 women and 79 men, median age, 46.3±2.3 yo). The lesions included 9 anterior cerebral artery aneurysms, 6 in posterior communicating artery, 35 in middle cerebral artery, 34 in anterior communicating artery, 1 in ophthalmic artery, and 18 in internal carotid artery aneurysms. The ratio of men and women with aneurysmal SAH was 1:1, which demonstrated different results comparing with the countries such as Japan, Austria and Canada. Two patients died after operation due to cerebral vasospasm, who were admitted to our hospital with the WFNS grade III-IV after SAH. The postoperative hemiparesis accounts 4.8% (5 cases). After short-term observations (3 months) 4 of these patients showed a good recovery of paralyzed extremities. One patient missed out of follow up. Surgically related complications like mental change, temporal muscle atrophy were about 4%-8%. (The difference between two methods is P<0,009). The average duration of hospital stay was 8.2 ±2. ConclusionsSubtemporal, subfrontal, and paranasal key hole with pterional approaches have several advantages over the traditional craniotomies, including minor tissue damage, less brain retraction, a superior cosmetic results, and shorter duration of surgery and hospital stay. The operative field becomes wider in the deep area, providing sufficient space for microscope-assisted surgeries without need of highly specialized instruments.
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Objective To explore the microanatomy technique of the endoscopy-assisted extreme lateral supracerebellar infratentorial keyhole approach and clinical significance.Methods The extreme lateral supracerebellar infratentorial keyhole approach was imitated in 10 vascular perfusion adult cadaveric heads fixed in formalin,the dorsolateral mesencephalon region was dissected and observed by microscopy and neuroendoscopy from December 2012 to March 2013.Results The extreme lateral supracerebellar infratentorial keyhole approach could be fully exposed the ambient cisterns,the posteromedial tentorial incisura,the dorsolateral mesencephalon region,the trochlear nerve,the root of the trigeminal nerve,the superior cerebellar artery,the posterior cerebral artery and other important anatomical structures.The temporal lobe and parahippocampal gyrus could be exposed when the tentorial was incised.The application of neuroendoscopy could clearly reveal the trigeminal nerve and surrounding structures.Conclusion The extreme lateral supracerebellar infratentorial keyhole approach is suitable for the surgical resection in dorsolateral mesencephalon region.The application of neuroendoscopy can make up for the lack of the trigeminal nerve observed under microscopy and expand the operative field.
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Objective To study clinical effects and complications of minimal invasive neurosurgery for pituitary adenoma through superciliaryarch-keyhole approach. Methods 127 cases pituitary adenoma in three hospitals in Shangdong province from May. 2006 to Sept. 2009 confirmed by surgery were analyzed. Patients were treated by different operative approaches, 53 cases using surgery through superciliaryarch-keyhole approach and 74 cases through conventional subfrontal approach. Clinical parameters were compared in patients undergoing surgery through different approaches. Results There were no differences in two groups, in aspects such as resection rate, improvment of endocrine hormone secretion and acuity of vision with campus visualis, electrolyte disturbances, hypothalamus damage (P ＞0.05). Significant differeces reside in average hospitalization days, subcutaneous fluidify, psychiatric symptom and circumscribed cerebral ischemia ( P ＜ 0.05 ). Conclusion Advantages of minimal invasive neurosurgery through superciliary arch approach such as less trauma, better expose,shorter hospitalization days, less subcutaneous fluid accumulation and psychiatric symptoms in terms of this apporach are suitable for removing hypophyseal adenomas that grow on or around sella turcica.
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@#Objective To explore and evaluate the micro-anatomic structure of posterior-middle cra nial fossa in the retrosigmoid keyhole approach for clinical application. Methods Ten formalin-fixed adult cadaver heads of 20 sides were used to apply the retrosigmoid keyhole approach to reach and observe the structure of posterior-middle cranial fossa.Results The retrosigmoid keyhole approach can reach petroclival region from post-lateral aspect and through this approach the lateral potion of cerebellar hemisphere、petrosal bone,CN Ⅴ,Ⅶ,Ⅷ,part of CN Ⅸ-Ⅻ,lateral potion of pons、vertebral artery and anterior inferior cerebellavar artery can be exposed cleady.Resecting part of supra-tubercle of IAM can enlarge the exposure of IAM and CN V.After cutting off the edge of tentorial part of CN Ⅳ and middle cranial fossa can be exposed.Conclusion Through retrosigmoid keyhole approach we can use the small but compatible bone hole to diminish the ineffective exposure of the cerebellum.Meanwhile the wound because of the approach and complication can be cut down.It's an effective,safe and convenience approach in clinical application to resect the tumor mainly located in posterior cranial fossa.
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Objective To explore the feasibility and operation methods of interforniceal diaterma keyhole approach for operative therapy of apex basilar artery aneurysm. Methods Interforniceal diaterma keyhole approach was designed to interpeduncular cistern with diaterma incision from tuber cinereum to posterior perforated substance and between bilateral mammillary bodies. The simulation operations of interforniceal diaterma keyhole approach were performed in 16 cadaveric heads by assisting with Stryker neuronavigation. Anatomic structures were observed by surgical microscope and measured by Stryker neuronavigation in the keyhole approach operations. Results The operations of interforniceal diaterma keyhole approach could be accomplished successfully in 16 cadaveric heads. The distances from bregma to superior margin of interventricular foramen, superior margin of adhaesio interthalamica, mammillary body, superior margin of aqueduct of midbrain and bifurcation of basilar artery were (68.4±4.6)mm, (66.3±6.0)mm,(86.3±5.3)mm, (82.0±7.6)mm and (91.8±5.0)mm respectively. The length of surgical window of diaterma was (9.5±2.6)mm from tuber cinereum to posterior perforated substance between bilateral mamillary bodies. The apex of basilar artery, P1 and P2 of posterior cerebral artery, superior cerebellar artery, posterior communicating artery and perforating branches from them could be exposed distinctly in interpeduncular cistern. The scope of operative exposure region was front to clivus and dorsum sellae by dissected the Liliequist panniculus, lateral to oculomotor nerve and posterior to interpeduncular fossa. The bifurcation of basilar artery apex was deviation to left in 68.8%. The bilateral posterior cerebral arteries were oblique to the anterolateral in 68.8%. There were 1-4 perforating branches from the apex of basilar artery in the included angle of bilateral posterior cerebral arteries. Conclusion Interforniceal diaterma keyhole approach is feasible for technique. It is worth of implementing and perfecting in surgical therapy of the apex basilar artery aneurysm.
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Background To investigate the feasibility of a novel anterior subtemporal transepidural-anterior transpetrous keyhole approach assisted by neuronavigation in attempt to apply the keyhole conception to imitate a new keyhole approach and to observe microanatomical structures, which can be regard as the base of this approach for clinical use. Methods The new keyhole approach was imitated by using ten adult cadaveric heads fixed in 10% formalin and perfused intracranial vessels with colored silicone. Under operative microscope, the anatomic structures were observed and important structures were measured after the maximal anterior petrous bone removal and the cavernous sinus exposure. Results The approach could provide a full visualization for the lateral structures and the internal contents of the cavernous sinus. The upper and middle clivus, the cerebellopintine angle, basilar artery and anterior inferior cerebellar artery were exposed after the maximal anterior petrous bone removal. Conclusions It is feasible to perform the anterior subtemporal transepidural-anterior transpetrous keyhole approach on operation of lesions involved in the cavernous sinus or/and the upper and middle clival regions.
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Objective To explore the effect and technical skills of neruoendoscope-assisted microneurosurgery via the supraorbital keyhole apporach for giant olfactory groove meningiomas.Methods A total of 12 patients with giant olfactory groove meningiomas(≥7 cm in diameter)received neruoendoscope-assisted microneurosurgery via the supraorbital keyhole approach.Data of the patients were analyzed retrospectively.Results Among the cases,9 achieved complete resection of the tumor,inlcuding 5 cases of SimpsonⅠ and 4 cases of Simpson Ⅱ.The other 3(Simpson Ⅲ)patients underwent subtotal resection.None of the patients died during the operation.Ten of the patients were follwed up for 3 months to 2 years(mean,14 months).During the follow-up,9 of the 10 resumed physical and sporting activities,and the other one retured to normal daily life.MRI examination was prefomred on 9 patients,none of them had recurrence.Conclusions Neruoendoscope-assisted microneurosurgery via the supraorbital keyhole approach is effective and safe for patient with giant olfactory groove meningioma.The tumor should be removed piece by piece during the operation.
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Objective To study the feasibility of trans-supraorbital keyhole approach microsurgery for sellar tumors.Methods The operation was conducted under combined intravenous general anesthesia and the patient was maintained at a dorsal position.A skin incision was made along the lateral eyebrow at 3.5~4.0 cm in length.The frontal muscle periosteous flap was draged upwards and the orbicularis muscle periosteous flap was dragged downwards.Then the tempotal muscle was dragged laterally.The position of the keyhole was located behind the temporal line.By using a milling cutter,a bone window 2 cm ? 3 cm in size was made medially.The inner margin of the supraorbital skull was shaped to expand the visual field of microsurgery.The cerebral dura mate was opened curvily,with the base directing to the orbital margin.The frontal lobe was elevated gently and the cerebrospinal fluid was drained.The tumor was fully exposed and resected.Results Total resection of tumor was achieved in 22 cases,and part of posterior tumor membrane remained in 2 cases of craniopharyngioma.Hypoadrenocorticism occurred in 1 case of ACTH adenoma after operation and a hormone replacement therapy was required. Temporary postoperative diabetes insipidus occurred in 8 cases and was relieved after 1 week.The postoperative urinary volume decreased significantly in 9 cases of preoperative diabetes insipidus.Visual disorder on the operational side was aggravated after operation in 1 case of tuberculum sellae meningioma,and was gradually improved after 1 week.No recurrence was observed under MRI examination in 18 cases at 3 months after operation.Conclusions Trans-supraorbital keyhole approach microsurgery is feasible,and it gives minimal operational trauma,thorough resection of tumor,and good cosmetic outcomes.
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Objective To discuss the technique of supraorbital transeyebrow keyhole approach microsurgery for sellar tumors. Methods A total of 33 cases of sellar tumors were treated in this hospital from July 2001 to June 2004. The resection of the tumor was achieved by way of a supraorbital eyebrow minicraniotomy through a 2.0 cm ? 3.0 cm keyhole approach. The surrounding cisterns of the sellar area were opened to expose underlying structures under microscope at proper angles. Results Of 26 cases of hypophysoma, a total resection was performed 19 cases, and a subtotal resection in 7 cases. Of 4 cases of craniopharyngioma, a total resection was performed 3 cases, and a subtotal resection, 1 case. One case of meningioma received a total resection, and 1 case of optic chiasm glioma underwent a partial resection. Postoperatively, transitory diabetes insipidus was observed in 5 cases, and grand mal epilepsy occurred in 1 case. There were no infection or bleeding after the operation. All the 33 cases were followed for 4~36 months (mean, 27 months). No recurrence of tumors was seen in the 24 cases of total resection. Postoperative radiotherapy was given in 7 cases of subtotal resection of hypophysoma, 1 case of craniopharyngioma, and 1 case of optic chiasm glioma, and no apparent enlargement of tumors was found. Conclusions Supraorbital transeyebrow keyhole approach microsurgery minimizes the unnecessary exposure of the brain and postoperative complications.
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Objective This study is to explore the infratentoriat-supracerebellar keyhole approach for microsurgical treatment of pineal region tumors and to evaluate its curative efficacy and safety.Methods According to hi-fi quality MRI images,individual operation schemes were designed.Microsurgical infratentori- al-supracerebellar keyhole approach was used to resect lesions in 7 consecutive patients with prone postition.A 2.0 cm?2.5 cm surgical bone window was performed with its superior margin reaching to the inferior margin of the transverse sinus and confluence sinus.Results Among the 7 pineal region tumors,there were 2 ger- minomas,2 pineocytomas,1 pineoblastoma,1 glioma and 1 chlesteatoma.All cases were re-examined with MRI after operation and it was found that 6 lesions were totally removed and 1 was subtotally removed.The outcome of the treatment was satisfying.There was no infection,bleeding or death after surgery.The follow-up result in the near future was good.Conclusion The infratentorial-supracerebellar keyhole approach for the excision of pineal region tumors was proved to be a satisfactory means with a total removal rate,an excellent curative effect and small surgical trauma.
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Objective To evaluate the possibility of keyhole approaches for surgical treatment of petroclival meningiomas. Methods We retrospectively analyzed our experience in 14 cases with petroclival meningiomas surgically treated from May 2003 to January 2004. Eight tumors involved the upper and middle clivus.five tumors were attached to the entire width of clivus and one tumor involved the middle and lower cilvus. The tumors infiltrated into parasella regions or cavernous sinus in six cases simultaneously. Retrosigmoidal keyhole approach was selected to remove the tumors in 6 cases, and subtemporal keyhole approach was selected in 2 cases,while the combined retrosigmoidal and subtemporal keyhole approaches were applied in other six cases. Results Gross total resections of the tumors were achieved in 8 cases, subtotal resections in 4 cases, large resection in two cases who had recurrent tumors. Postoperatively, neurological intact or unchanged were found in 8 cases. The main surgical complications were mild facial palsy (4 cases) , abducent dificits (3 cases) ,temporary oculomotor nerve dificits (2 cases),and lower cranial nerve palsy (1 case). One patient died from disseminated intravascular coagulation (DIC) two weeks after surgey. There were no CSF leakage and infections after surgery in all cases 11 to 19 months follow-up studies demonstrated the great improvement of the Ⅲ and Ⅶ nerve deficits,but minor improvement in the Ⅵ nerve deficits. Conclusion According to the location and extension of the tumors, retrosigmoidal or subtemporal keyhole approaches or their combined can be selected for surgical treatment. These keyhole approaches can expose sufficiently the petroclival region, shorten the surgical time, and minimize the complications. Combined usage of minimally invasive techniques including the keyhole approach and radiosurgey in the treatment of the petroclival meningiomas is suggested.
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Objective To discuss the operation effect and the role of neuroendoscope which was used to assist the keyhole approach in treatment of intracranial aneurysms Methods The keyhole surgery with the assistant of neuroendoscope was used to treat 14 cases of aneurysm After initial exposure of pterional or superciliary arch keyhole approach with the aid of microscope,the rigis endoscpe was introduced to confirm regional anatomy,including the aneurismal neck and adjacent structure After clipping,introduced again to inspect the positions of the clip and nearby structures. Results After operation,all the 14 cases were recovered without any severe complication. Conclusions There was a sufficient exposure in the visualization of the anatomy of the aneurysm and surrouding structures,the injuries of operation were relieved,the time in operation and hospital can be shortern,as well as reliable operation effect.
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To study the procedure in cutting intracranial minimal lesions, intracranial minimal lesions were removed in 9 cases (male 6, female 3.) through keyhole in the guidance of frameless stereotaxy with robot. Robot image navigation orientation system was used to provide 3D images, and then these markers were made sure the coordinates of lesion target to guide the operating approach, locating anatomical structures,size of lesion and lesions to be removed in all the patients. Cases included 2 meningiomas, 2 brain abscess, 1 cyst of cysticercosis, 1 angiocavernoma, 1 metastasis tumors, 1 granuloma and 1 foreign body of metal from Mar 1, 2001 to June 1, 2001. The robot frameless stereotaxy provided accuracy of the intracranial lesions and anatomy. The postoperative neurofunction defects were not found. The outcome of operation was very good. The robot navigation system provided surgical navigational function: localization, orientation and guidance of the cutting intracranial minimal lesions in exact. It is useful in minimally invasive neurosurgery and is a good therapeutic method.