Quantitative and Qualitative Analysis of the Working Area Obtained by the Microscope and Endoscope in Different Surgical Approaches to the Acom and BA Region

Endoscopy-assisted microneurosurgery gained special attention by neurosurgeons in the last decade. The advantage of using the endoscope in an assisted manner goes to smaller incision, limited bone removal, decreased retraction of the brain, and better target visualization.

Purpose The purpose of our study was to evaluate in a quantitative and qualitative way the surgical exposure and the ability to operate on the Acom and BA are using endoscopic-assisted microneurosurgery.

Material and Methods We performed nine dissection including supraorbital, pterional, and orbitozygomatic approaches bilaterally on five whole fresh cadaver heads. Dissections were performed under operating microscope (Pentero, Carl Zeiss) and Stryker rigid endoscope (4 mm in diameter, 18 cm in length). Working area was defined as area visualized in surgery in which we were able to perform surgical maneuvers.

Results The endoscopic area was larger than microscopic one in all approaches examined. Microscopic area increased as more bone was removed. The endoscopic supraorbital approach was comparable to the orbitozygomatic microscopic working area.

Conclusion Our laboratory study showed that, in our model, the amount of working exposure achieved in smaller craniotomy using the microscope–endoscope combination was similar to the one obtained using larger craniotomy when the microscope was the only surgical tool.