Publication year: 2012
Source: World Neurosurgery, Available online 10 February 2012
Robert Reisch, Axel Stadie, Ralf A. Kockro, Nikolai Hopf
ObjectiveImprovements in preoperative diagnostic imaging as well as in microsurgical techniques significantly advanced the development of transcranial neurosurgery allowing the treatment of complicated diseases through smaller and more specific approaches.MethodsIn this article, authors overviewed their surgical experience inTranscranialEndoscope-AssistedMicrosurgical treatment (TEAM), using limited sized keyhole craniotomies. Over a 10-year period, authors treated more than 3000 patients according to the TEAM concept, advanced by the pioneer of minimally invasive neurosurgery, Axel Perneczky.Results and ConclusionIn all cases, meticulous preoperative planning was performed determining site, size and optimal placement of the craniotomy as well as the trajectory towards the surgical target. Most importantly, the surgical approach was performed either completely or at least under permanent presence of the responsible senior surgeon from the moment of patient positioning until wound closure. The minimal invasive keyhole approaches allowed safe intraoperative control and adequate dealing with intracranial lesions. Essential pre-conditions for keyhole surgery were 1. careful selection of cases, 2. accurate praeoperative planning, 3. placement of the craniotomy tailored to the individual case and 4. intraoperative use of TEAM techniques. Advantages of intraoperative endoscopic visualization were increased light intensity, extended viewing angle, and clear depiction of details even in hidden parts of the surgical field.
Júlio Leonardo B. Pereira
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