| Objective (1) To clear out the best position of skin incision and craniotomy via callosum anterior interhemispheric ,supraorbital, pterional keyhole approach. (2) Observe the information of the anatomic structure in the sellar region via three various keyhole approach. (3) Measure pathway length from different superfic anatomic landmark to every important anatomic structure exposed by various keyhole approach. Arrange and analyze. (4) Probe different indication of three various keyhole approach through being carried out in clinic. (5) To analyze the using value of the endoscope through anatomy study and intraoperative utilization. (6) To compare the keyhole approach with the ancient craniotomy of the big bone flap, such as anterior interhemispheric approach, subfrontal approach and pterional approach. To summarize the advantage or the disadvantage of the keyhole approach and advertent issue in clinic.Methods To design and carry out procedure via anterior interhemispheric , supraorbital and pterional keyhole approach on 11 specimens of formalin-fixed adult corpse-capita. (1)AIKA: the incision length is 5cm and locating at interval 4.5cm from glabella. Burr hole and open a 3×2.5cm craniotomy at interval 3cm from glabella. The sheared dura was turned over toward sagittal sinus. To reach saddle area along callosum anterior border. (2)SKA: the medial margin of incision situate at the 1/3 inner junction of supraorbital arch(foramen sive incisura supraorbitalis) and the lateral extend to the lateral border of eyebrow a little. To bore a hole behind the zygomatic process of frontal bone and open a 3×2.5cm craniotomy along the supraorbital arch, the anterior border of craniotomy equal to the anterior cranial fossa. To enter the saddle region along the bottom of frontal lobe. (3)PKA: the medial margin of incision locate slightly at thelateral of the juncture of vertical line between eyebrow and pupil and extending to the eyebrow lateral 2cm. To bore a hole behind the zygomatic process of frontal bone and open a 3x2.5cm craniotomy. The craniotomy is conducted around the level of the frontal base and the superior margin to supratemporal line and the lateral edge to the sphenoid wing lateral; the saddle area were exposed through the cistern of lateral sulcus. (2) To observe the characteristic of different structure through using the microscope and to measure the date relating to various craniotomy. (3) various microanatomic structure that can not been exposed by the microscope could been showed through using the endoscope. (4)6 cases of tumor were removed via AIKA approach, 34 cases were removed via SKA approach and 31 cases were removed via PKA approach.Result Some important structures such as anrerior communicating artery complex, optic chiasma, lamina terminalis can be exposed through a trans-anterior interhemispheric. The first diastema(the anterior diastema of chiasm opticum) and fourth diastema(the post-diastema of chiasm opticum)can be showed with a visual angle of approximate perpendicularity. Among 6 cases in clinical application, tumor was totally removed in 5 cases,sub totally removed in 1 cases. Some structures locating at the anterior cranial fossa and the area between the first diastema and third diastema can be exposed through the supraorbital keyhole approach, especially the first diastema can be exposed better.among 34 cases, tumor was totally removed in 27 cases,sub totally removed in 5 cases, major part removed in 2 cases, different structures locating at the anterior cranial fossa and the area between the first diastema and third diastema can be exposed through the pterional keyhole approach, especially the second diastema and the third diastema can be exposed better. Among 31 cases, tumor was totally removed in 27 cases,sub totally removed in 3 cases, major part removed in 1 cases. There were no severe complication and operative death in all cases. |
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