SUBTEMPORAL KEYHOLE APPROACH TO THE SUPRASELLAR AND PETROCLIVAL REGION - MICROANATOMIC CONSIDERATIONS AND CLINICAL-APPLICATION

OBJECTIVE: To minimize surgical invasiveness, the keyhole concept is a pplied to the subtemporal approach. METHODS: Anatomic features were st udied in 14 sides of adult cadaver heads, and the technique was used i n 162 interventions. Although most of the lesions treated were 3 cm in size or smaller, larger lesions were also treated using this techniqu e. In some cases, if needed, an endoscope-assisted microsurgical techn ique was used, RESULTS: The cadaveric study provided intimate experien ce with the microsurgical anatomy of the approach. The 162 consecutive patients who were operated on harbored various types of lesions; the most recent 43 consecutive interventions were investigated in detail. The complications encountered included five cases of permanent cranial nerve palsy, two cases of cerebrospinal leakage, two cases of short m emory disturbance, two cases of seizure, and one case each of hemipleg ia and incoordination, transient hearing loss and tinnitus, and consci ousness deterioration and hemiplegia. CONCLUSION: With careful patient selection, the subtemporal keyhole approach diminishes tissue traumat ization considerably and has proven to provide sufficient operating sp ace in the suprasellar area. When this approach is combined with the c ranial base technique, the petroclival region can also be treated. How ever, the subtemporal keyhole approach requires deliberate preoperativ e planning for each patient, as well as for each surgeon.