Endoscopic anatomical study of the upper peroclival region and suprasellar region via subtemproal keyhole approach

Abstract

Objective To study the endoscopic anatomical characteristics of the upper petroclival and suprasellar region via subtemproal keyhole approach and to explore the clinical feasibility of this approach to these regions.Methods The operation of subtemporal keyhole approach was performed bilaterally in ten adult cadaver heads fixed with formalin and injected with colored emulsion.The anatomical structures in the upper petroclival region under the endoscope and microscope were recorded.Results Without removal of the zygomatic arch,most of structures in upper petroclival region and suprasellar region were observed under endoscope,including bilateral side anatomical structures; and most perforating branch arteries could be clearly displayed.The natural intracephalic spaces,including posterior communicating artery (PcoA)-oculomotor nerve,posterior communicating artery-anterior choroidal artery (AchA) were important spaces.The stripping of petrous apex and posterior clinoid process could be performed to obtain the ideal surgical exposure.The endoscopic structures in upper petroclival region and suprasellar region may be localized by combination of different markers; the bony structure,such as orifice of internal auditory canal,could be applied as markers.Conclusion The endoscope-assisted neurosurgery through subtemporal keyhole approach is very helpful in exposing the lesions of the upper petroclival and suprasellar region,which minimizes the trauma and is useful in practice. Key words: Subtemporal keyhole approach; Endoscope; Upper petroclival and suprasellar regions; Anatomy