Artikel
The importance of intra-operative endoscopic visualization performing supraorbital craniotomy
Bedeutung der endoskopischen intraoperativen Bildgebung bei Durchführung eines supraorbitalen Zuganges
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Autoren
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Robert Reisch
- Neurochirurgische Universitätsklinik, Mainz
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I. Gawish
- Neurochirurgische Universitätsklinik, Mainz
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A. Perneczky
- Neurochirurgische Universitätsklinik, Mainz
| Veröffentlicht: | 23. April 2004 |
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Gliederung
Text
Objective
The supraorbital approach through an eye-brow skin incision offers wide intracranial exposure treating different intracranial lesions. However, in some cases visualization of the deep seated structures becomes limited, according to the enormous loss of light through the limited size of key-hole craniotomy.
Methods
Between January 1993 and December 2002, 1013 supraorbital approaches were performed in our neurosurgical department. During this ten-year period the first and senior authors have performed 367 supraorbital craniotomies, these cases were retrospectively analyzed reviewing office charts, medical reports, and radiographs. Records were available from 343 patients allowing thorough evaluation of the pre-, intra-, and postoperative course. From the 343 patients 154 patients were operated with intracranial aneurysms, 76 with skull-base meningiomas, 36 with craniopharyngiomas, 22 with pituitary adenomas, 16 with frontotemporal lesions, 15 with deep seated brainstem lesions, 4 with arachnoidal cysts and 15 with other miscellaneous supra- or parasellar lesions. In 5 cases selective amygdalohippocampectomy was performed through the supraorbital approach.
Results
In the group of aneurysms endoscopes were used in 49 cases (32%), in the group of meningiomas in 10 cases (13%), in the group of craniopharyngiomas in 11 cases (30%), in the group of pituitary adenomas in all cases (100%), in the group of frontotemporal lesions in 3 cases (19%), in the group of deep-seated brain-stem lesions in 11 cases (73%), in the group of arachnoid cysts in all cases (100%) and in the group of different supra- or parasellar lesions in 7 cases (46%). Performing selective amygdalohippocampectomy, endoscopes were not used. During surgery, the endoscope assisted or controlled technique allowed safe intraoprative anatomical orientation and exact control of tumor removal or clipping procedure.
Conclusions
The endoscope assisted technique offered exquisite optical control through the limited supraorbital craniotomy. The use of endoscopes allowed accurate and safe surgical dissection especially in the surgery of deep-seated lesions.
