Endoscopic extradural subtemporal approach to lateral and central skull base: a cadaveric study

Area of Science:

• Neurosurgery
• Surgical Anatomy
• Minimally Invasive Surgery

Background:

• Endoscopic endonasal surgery offers less invasive skull base access but has limitations.
• Potential complications can restrict the application of current endoscopic skull base techniques.

Purpose of the Study:

• To assess the feasibility of a purely endoscopic extradural transcranial approach to the lateral and central skull base via a subtemporal keyhole.
• To evaluate potential anatomical distortions associated with this endoscopic approach.

Main Methods:

• Ten fresh cadaver heads were utilized for surgical approach development.
• 4-mm 0° and 30° endoscopes were employed to identify surgical landmarks.
• The extradural space in the middle cranial fossa was exposed to delineate the approach.

Main Results:

• The endoscopic extradural subtemporal approach successfully exposed key anatomical structures.
• The technique allowed visualization of the lateral cavernous sinus wall, infratemporal fossa, and anterior/posterior cranial fossae.
• Structures including the tympanic cavity and facial nerve were clearly identified via this keyhole route.

Conclusions:

• The endoscopic extradural subtemporal approach is a feasible surgical technique.
• This method provides extensive visualization of lateral and central skull base structures with minimal invasiveness.
• Utilizing the extradural space is crucial for safe and effective endoscopic skull base surgery.