• Bingwei Song, Qing Wang, Zhemin Ding, and Xiaojie Lu.
• Wuxi Clinical Medical College of Nanjing Medical University, Wuxi, Jiangsu Province, China.
• World Neurosurg. 2023 Oct 1; 178: e156e164e156-e164.

ObjectiveWe sought to assess the feasibility of endoscopic lateral and superior cerebellar keyhole approach for exposure of the anterior and middle incisural space and Meckel cave.MethodsThe endoscopic lateral and superior cerebellar keyhole approach was performed in 6 cadaveric heads (12 sides) using 0- and 30-degree endoscopes, respectively. The anatomic structures for this approach to the anterior and middle incisural space and Meckel cave were observed.ResultsBy grinding out the suprameatal tubercle and petrous apex and incising the tentorium, the anatomic structures in the anterior incisural space were visualized. The mean area exposed with a 0-degree endoscope in the anterior incisural space was 212.50 ± 6.04 mm2, significantly less than that exposed with a 30-degree endoscope (233.83 ± 8.72 mm2) (P < 0.05). The anatomic distance of the Meckel cave in the depth was the same between a 0-degree endoscope and a 30-degree endoscope; however, the distance in the width was 9.48 and 12.32 mm, respectively (P < 0.01). The area of petrous window grinded by a 30-degree endoscope was only increased by 5.83 mm2, compared with a 0-degree endoscope (P > 0.05).ConclusionsThis approach provides access to the anterior and middle incisural space and Meckel cave, which is feasible to clearly expose the anatomic structures in those regions with minimal invasiveness. Additionally, better visualization and surgical space can be achieved under a 30-degree endoscope.Copyright © 2023 Elsevier Inc. All rights reserved.

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