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Knowledge of anatomy is essential to understand human biology and medicine. Anatomists and health care professionals use standard terminology to describe the human body with more precision and no ambiguity. Anatomical terms have mostly Greek and Latin-derived roots. Because these languages are rarely used in conversation, the meaning of words remains the same. Each term is made up of a root in between the prefixes and suffixes. The root of a term often refers to an organ, tissue, or condition,...
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Related Experiment Video

Updated: Feb 8, 2026

Author Spotlight: Scope of LE-ULBD as a Safe, Effective, and Minimally Invasive Approach to Treat Lumbar Spinal Stenosis
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Endoscopically Assisted Targeted Keyhole Retrosigmoid Approaches for Microvascular Decompression: Quantitative

Evgenii Belykh1, Naomi R Onaka2, Xiaochun Zhao2

  • 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.

World Neurosurgery
|July 1, 2018
PubMed
Summary

Minimally invasive keyhole retrosigmoid approaches offer comparable surgical access to cranial nerve complexes in the cerebellopontine angle (CPA) as conventional methods. Endoscope assistance enhances visualization of delicate neurovascular structures during these CPA surgeries.

Keywords:
EndoscopeEndoscopic assistanceMicroscopeMicrovascular decompressionNeuralgiaOperativeRetrosigmoid craniotomy

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Microvascular Decompression: Salient Surgical Principles and Technical Nuances
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Area of Science:

  • Neurosurgery
  • Minimally Invasive Surgery
  • Cranial Nerve Surgery

Background:

  • The cerebellopontine angle (CPA) is a critical surgical area housing complex neurovascular structures.
  • Conventional retrosigmoid craniotomy provides broad but invasive access.
  • Keyhole approaches aim to reduce invasiveness while maintaining adequate surgical corridors.

Purpose of the Study:

  • To quantitatively assess and compare minimally invasive keyhole retrosigmoid approaches with conventional retrosigmoid craniotomy.
  • To evaluate surgical freedom and angles of attack to cranial nerve (CN) complexes in the CPA.
  • To explore the utility of endoscope assistance in keyhole CPA surgery.

Main Methods:

  • Anatomical dissections on 10 cadaver sides using fixed, silicone-injected specimens.
  • Assessment of surgical views via endoscopic videos and 3D virtual reality microscope.
  • Comparison of surgical freedom and angles of attack (horizontal and vertical) using neuronavigation.

Main Results:

  • Conventional approach offered superior surgical freedom except at specific distal CN V, root CN VII, and root CN IX locations.
  • Conventional retrosigmoid provided a larger horizontal angle of attack than keyholes.
  • Splitting the petrosal fissure improved vertical angles of attack to CN V and VII root zones.
  • Endoscope-assisted keyhole approaches were illustrated for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia.

Conclusions:

  • Targeted keyhole retrosigmoid approaches necessitate a thorough understanding of CPA 3D anatomy for optimal corridor creation.
  • Endoscope assistance is valuable in keyhole CPA surgery, enhancing visualization of neurovascular structures.
  • Keyhole approaches can be effective for specific CPA pathologies when combined with advanced techniques.