Endoscopic assistance in the epidural subtemporal approach and Kawase approach: anatomic study.

BACKGROUND: Few reports exist in the literature about the use of endoscope assistance in the identification of structures in the posterior fossa. OBJECTIVE: To asses the advantage of endoscopic assistance in the epidural subtemporal and Kawase approaches by studying anatomic exposure and surgical freedom in the posterior cranial fossa. METHODS: Twelve epidural subtemporal approaches were performed on 6 adult cadaveric heads. On the same specimens, 6 endoscope-assisted subtemporal approaches and 6 Kawase approaches were then performed. At the end of each Kawase approach, endoscope assistance was used. The microsurgical observations were performed with a surgical microscope with magnification ranging from 4 x to 40 x. Endoscopic observations were made with a 0 degrees , 4-mm rod-lens endoscope. Anatomic exposure and surgical freedom were analyzed. RESULTS: Endoscopic assistance during the epidural subtemporal approach increased the anatomic exposure 3 mm superiorly, 20 mm infe