Clinical application of anterior subtemporal keyhole approach microsurgery

Objective Based on the rationale of "keyhole" minimally invasive neurosurgery, the normal subtemporal approach was modified to decrease the surgical trauma. Methods A straight skin incision of 4cm was made, just in front of the ear and above the zygomatic arch. Afterwards, a bone window with a diameter of 2.0~2.5cm was opened. 13 operations via the subtemporal keyhole approach were performed to deal with lesions located at cavernous sinus, brain stem and petroclival region. Results Among 6 petroclival meningiomas, 4 were resected totally, 1 subtotally and 1 mostly. One metastasis cancer in the brain stem and one temporal glioma, as well as one thrombus at the cavernous sinus, were removed totally, while one meningioma at the cavernous sinus and one glioma at the pons were subtotally removed. Additionally, one bleeding pontine AVM was removed successfully, together with the hematoma. One aneurysm located at the cerebral posterior artery was clipped successfully. Only one patient suffered from postoperative cerebrospinal fluid otorrhea, which was cured later by successful reparation via the same approach. Two patients presented hemiparesis after petroclival meningiomas resected. Conclusion This subtemporal "keyhole" approach can meet surgical requirements for lesions located at petroclival region, ventral and lateral parts of the pons as well as cavernous sinus. It is an effective and practicable approach for minimally invasive operations.