9 Principles of Minimally Invasive Keyhole Surgery

  • Varun R. KshettryEmail author
  • Tyler J. Kenning
  • James J. Evans
  • Christopher J. Farrell


The primary principle of keyhole cranial surgery is to maximize surgical efficiency by minimizing approach-related disruption while maintaining optimal ability to safely perform the operation. Keyhole cranial approaches include the supraorbital, mini-pterional, keyhole subtemporal, retrosigmoid, pineal, transventricular, and transcortical approaches. Keyhole approaches require careful preoperative planning to determine the optimal surgical trajectory with careful evaluation of normal and pathological anatomy. The endoscope can be an invaluable tool in keyhole approaches to increase illumination along the surgical corridor and look around structures that cannot be mobilized. In this chapter, we discuss the principles of keyhole cranial surgery and highlight nuances regarding individual keyhole approaches.


Keyhole Minimally invasive Endoscopic-assisted Supraorbital Mini-pterional 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Varun R. Kshettry
    • 1
    Email author
  • Tyler J. Kenning
    • 2
  • James J. Evans
    • 3
  • Christopher J. Farrell
    • 3
  1. 1.Skull Base, Pituitary and Cerebrovascular Surgery, Department of NeurosurgeryCleveland ClinicClevelandUSA
  2. 2.Pituitary and Cranial Base Surgery, Department of NeurosurgeryAlbany Medical CenterAlbanyUSA
  3. 3.Cranial Base and Pituitary Surgery, Department of NeurosurgeryThomas Jefferson UniversityPhiladelphiaUSA

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