Endoscopic dissection of dura and craniotomy with minimal trephines: a preliminary series

The first nine clinical cases using endoscopic dissection of dura and craniotomy with minimal trephines were performed from June to August 1997 after trial dissection of 19 fresh cadavers conducted at the University of Brno's Pathology Institute in the Czech Republic. These procedures involved the refinement of craniofacial and intracranial surgical techniques using the endoscope and prototype instruments. These dissections demonstrated that intracranial structures can be explored using an endoscope without encumbrance, and that major craniofacial surgeries may also be performed with minor incisions and minimal craniotomies. Furthermore, we seek to illustrate that use of the endoscope in craniofacial surgery provides improved visualization and protection of vital structures while simultaneously allowing the surgeon to perform delicate maneuvers. This permits minimal brain retraction with less subsequent morbidity. This minimally invasive craniofacial-intracranial surgical technique using the endoscope is performed with minimal cutaneous incisions, avoiding wide exposure of subcutaneous tissue, cranium, and meningeal structures. The ultimate goal is to perform endoscopic intracranial osteotomies and obtain advancement of craniofacial skeleton with gradual distraction. Potential neurosurgical advantages include improved postoperative recovery, decreased cerebral edema, and decreased risk of hemorrhage and infection.