Endoscopic Assistance in Surgery for Insular Lesions: Anatomic Study and Clinical Application

Area of Science:

• Neurosurgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Endoscopic assistance offers improved visualization in microsurgery.
• Its utility in insular lesion surgery requires further investigation.

Purpose of the Study:

• To evaluate the anatomic feasibility and clinical utility of endoscopic assistance in microsurgical management of insular lesions.

Main Methods:

• Cadaveric study using 6 fixed and 1 fresh human head specimens.
• Rigid endoscopes (30° and 45°) assessed insular microsurgical anatomy.
• Applied findings in 2 clinical cases (astrocytoma, cavernoma) via trans-Sylvian/transopercular approaches.

Main Results:

• Angled endoscopes provided superior visualization of deep surgical corridors and arteries.
• 45° endoscope aided subpial dissection beneath M2 branches.
• Endoscopic assistance enabled enhanced exposure with minimal retraction, safely performed in clinical cases.

Conclusions:

• Endoscopic assistance improves visualization of challenging insular anatomy.
• It may reduce brain retraction and facilitate safer dissection.
• Further studies are needed to establish its role in routine insular lesion surgery.