• Eberval Gadelha Figueiredo, André Beer-Furlan, Peter Nakaji, Neil Crawford, Leonardo C Welling, Eduardo C Ribas, Manoel J Teixeira, Albert L Rhoton, Robert F Spetzler, and Mark C Preul.
• Department of Neurology, Discipline of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil. Electronic address: ebgadelha@yahoo.com.
• World Neurosurg. 2015 Dec 1; 84 (6): 1907-15.

ObjectiveWe used microscopy with endoscopic assistance to conduct an objective analysis of 4 surgical approaches commonly used in the surgery of the ambient cistern: infratentorial supracerebellar (SC), occipital interhemispheric (OI), subtemporal (ST), and transchoroideal (TC). In addition, we performed a parahippocampalis gyrus resection in the ST context.MethodsEach approach (SC, OI, ST, TC) was performed on 3 cadaveric heads (6 sides). After the microscopic anatomic dissection, the 30-degree endoscope was used to explore the exposure. The parahippocampalis gyrus was resected through an ST approach and the exposure was evaluated. The quantitative analysis was based on linear exposure of the vascular structures (linear exposure), such as the posterior choroidal artery (PChA), the P2 and P3 segments of the posterior cerebral artery (PCA) with their branches, the basal vein of Rosenthal, and the area of exposure of the ambient cistern region (area of exposure) limited by points on its superior, mesial, and anterior walls. In all cases, a P value of less than 0.05 was considered significant.ResultsThere was a significant difference (P < 0.05) in linear exposure of the PCA and medial PChA between microsurgery and endoscopic assistance using the ST approach. This approach also improved the medial, superior, and total exposure of the ambient cistern region.ConclusionsThis study demonstrates that endoscope assistance improved exposure of the ambient cistern region when using the ST approach. Endoscopic assistance provided similar surgical exposure compared with ST associated with parahippocampalis resection.Copyright © 2015 Elsevier Inc. All rights reserved.

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