9 Principles of Minimally Invasive Keyhole Surgery
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.
KeywordsKeyhole Minimally invasive Endoscopic-assisted Supraorbital Mini-pterional
- 3.Cheng C-M, Noguchi A, Dogan A, Anderson GJ, Hsu FPK, McMenomey SO, et al. Quantitative verification of the keyhole concept: a comparison of area of exposure in the parasellar region via supraorbital keyhole, frontotemporal pterional, and supraorbital approaches. J Neurosurg. 2013;118(2):264–9.CrossRefGoogle Scholar
- 5.Yeremeyeva E, Salma A, Chow A, Ammirati M. Microscopic and endoscopic anterior communicating artery complex anatomy as seen through keyhole approaches. J Clin Neurosci Off J Neurosurg Soc Australas. 2012;19(10):1422–5.Google Scholar
- 9.Bander ED, Jones SH, Kovanlikaya I, Schwartz TH. Utility of tubular retractors to minimize surgical brain injury in the removal of deep intraparenchymal lesions: a quantitative analysis of FLAIR hyperintensity and apparent diffusion coefficient maps. J Neurosurg. 2016;124(4):1053–60.CrossRefGoogle Scholar