• Zhemin Ding, Xiaojie Lu, Qing Wang, Bing Li, Xinwei Qian, and Xiaoyong Liu.
• Department of Neurosurgery, The Affiliated Hospital of Jiangnan University and The Fourth People's Hospital of Wuxi, Wuxi, Jiangsu Province, China. Electronic address: zheminding@163.com.
• World Neurosurg. 2019 Apr 1; 124: e682e692e682-e692.

ObjectiveThe purpose of this study was to evaluate the advantages of endoscopy and navigational assistance in the intradural subtemporal keyhole approach and the intradural Kawase approach by studying anatomic exposure and surgical freedom in the posterior cranial fossa.MethodsTwenty endoscopic intradural subtemporal keyhole approaches (EISKA) were performed on 10 cadaveric heads. An intradural Kawase approach and a navigation-assisted intradural Kawase approach were then carried out on a random side of each specimen. Related anatomic structures were observed through a 0° endoscope and a microscope. Anatomic exposure and surgical freedom were measured by transparent graph paper and analyzed.ResultsCompared with the microsurgical technique, the superior, inferior, and medial limits of the endoscopic anatomic exposure increased by 2.9, 15.65, and 10.2 mm, whereas the surgical freedom increased by 2.9, 7.55, and 6 mm (P < 0.05) in the intradural subtemporal keyhole approach. In the intradural Kawase approach and the navigation-assisted intradural Kawase approach, the endoscopic anatomic exposure and surgical freedom also increased (P < 0.05). Using a frameless navigational device, the inferior limit of the anatomic exposure increased 3.8 mm by endoscopy and 3.5 mm by microscopy, whereas the surgical freedom increased by 2.7 and 2.2 mm, respectively (P < 0.05).ConclusionsThe EISKA provides greater anatomic exposure and surgical freedom primarily in the superior, inferior, and medial directions of the brainstem region. Maximum anatomic exposure and surgical freedom of the posterior cranial fossa was obtained by navigational assistance with fewer complications.Copyright © 2019 Elsevier Inc. All rights reserved.

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