Biportal Endomicrosurgery in the Intracranial Subarachnoid Space

Summary

While bi- or multiportal approaches to circumscribed indications have been adopted in all fields of surgery including spine surgery, the uniportal access to the skull is still a traditional principle in neurosurgery. Although sporadic microneurosurgical procedures using biportal endoscope-assisted techniques have been described, biportal endomicrosurgical dissection in the intracranial subarachnoid space has never been tested with respect to feasibility, utility, and safety in a preclinical study.

In 25 adult human cadavers, a total of 33 biportal endomicrosurgical dissections into and within the basal cisterns were carried out. Lensscopes of 0°, 30° and 70° with outer diameters of 4.2 mm and trochars with outer diameters of 5.0–6.5 mm were used for endomicrosurgical dissection.

Six different endoscopic routes to the basal cisterns and a total of ten different combinations of these approaches for biportal endoneurosurgery could be described, but it was found that not all of them were useful and safe.

Biportal endomicrosurgical subarachnoid preparations were effective and safe in the olfactory groove, the prechiasmatic cistern, the region of the optic chiasm, the entire suprasellar area, parts of the parasellar area, the pre- and perimesencephalic cisterns, and the prepontine cistern.