The Application Of "Key Hole" Technique In Microneurosurgery

Part â…  The anatomical study and clinical application of transeyebrow supraorbital approachObjective Intracranial anatomy and microanatomy in supraorbital keyhole approach is researched to provide anatomical basis for clinical keyhole operation. Methods To measure the relative distance and angle between the frontal-zygomatic process and landmarks of sellar area. 5 adults cadavers head sacked in formalin were studied with microscope via keyhole approach. Results Willis circle and sellar region can be reached via the approach by using microscope with different angle. Conclusions The anatomical data is available for clinical operation. The satisfied effect has been achieved in clinic via keyhole approach. Part â…¡ The Anatomical Study and Clinical Application of Temporal Keyhole ApproachObjective This study aim to explore the intracranial anatomy and microanatomy of neurosurgery of temporal keyhole approach to find anatomical basis for clinical keyhole operation. Methods 10 specimen of adult cadaver heads were collected and the following data was measured under microscope: the distance between the pterion and seller region, and that between the pterion and anatomical landmarks of the middle cranial base as well as the angle between them, which provided data basis for choice of various surgical instruments. At the same, the anatomical spaces of the seller region and middle cranial base were detected and observed. Results The available anatomical spaces through the temporal keyhole approach included the sylvian fissure, the prechiasmatic cistern, the optico-carotid triangle, the carotido-tentorial triangle and the space in the terminal lamina. And the sellar region , most part of the Willis circle , the iso-lateral subtemporal and tentorium region space could also be reached by this approach. Conclusions The temporal keyhole approach could cover all the fields that could be reached by pterion approach, including the sellar region, most part of the Willis circle and the iso-lateral subtemporal and tentorium region space. The exploration of microanatomical structures under temporal keyhole approach was helpful to clinical surgery and the anatomical datas were valuable for choices of surgical instruments. Part â…¢ The anatomic and clinical study of the keyhole technique to the posterior cranial fossaObjective This study aimed to study the normal structures of the posterior cranial fossa and investigate the keyhole technique in the posterior cranial fossa craniotomy. Methods Twenty-three dry skulls were observed and measured. Then a series of operations also modeled on fourteen adult cadaver heads by using microscopic skill. So, the keyhole of the posterior cranial fossa was located and applied to clinic. Results The most of normal structures of the posterior cranial fossa could be observed through the keyhole, including: the petrous apex, â…¤,â…¦-â…ª nerves, PICA, AICA, the posterior and lateral part of Meckels cave and the lateral part of the brainstem and so on. 13 cases , including 11 tumors, 2 trigeminal neuralgia, had been performed the operations using the keyhole technique of the posterior cranial fossa. Postoperatively, all of them had received a good outcome. Conclusion Appling the keyhole technique, neurosurgeon who possessed the perfective microneurosurgical technique can remove the near 3 cm lesions of the posterior cranial fossa. This technique has a lot of advantages to the posterior cranial fossa operations.