Anatomic study and clinical application of pterional keyhole approach

Objective To study the microanatomy of endoscope-assisted pterional keyhole approach with a skin incision of lateral eyebrow, and explore its useful value in clinics. Methods The microanatomy study was carried out on 12 specimens of formalin-fixed and 3 specimens of fresh adult corpse-capita performed through the pterional keyhole approach of simulating conditions, with a 3.0cm × 2.5cm miniaturized craniotomy after a skin incision of lateral eyebrow. The medioinferior edge of the craniotomy is conducted around the level of the frontal base and the lateral edge to the sphenoid wing. 23 cases of sellar region and anterior fossa tumor were removed via this approach. Results The structures of the anterior fossa and sellar regions can be exposed clearly by this approach. The blind area of microscope may be showed through neuroendoscope. Tumor was totally removed in 20 cases, subtotally removed in 2 cases, and partial removed in 1 case. There was no severe complication and no operative death. Conclusions The anatomy and clinic study showed that the pterional key approach providing similar information and minimal invasive procedure than classic pterional approach.