Mori Kentaro
Department of Neurosurgery, National Defense Medical College, Saitama, Japan.
Asian J Neurosurg. 2014 Jan;9(1):14-20. doi: 10.4103/1793-5482.131059.
The keyhole concept in neurosurgery is designed to minimize the craniotomy needed for the access route to deep intracranial pathologies. Such keyhole surgeries cause less trauma and can be less invasive than conventional surgical techniques. Among the various types of keyhole mini-craniotomy, supraorbital or lateral supraorbital mini-craniotomy is the standard and basic keyhole approaches. The lateral supraorbital keyhole provides adequate working space in the suprasellar to parasellar areas and planum sphenoidale area including the anterior communicating artery complex. Despite the development of neuro-endoscopic techniques and intra-operative assistant methods, the limited working angle to manipulate and observe deeply situated pathologies is a major disadvantage of the keyhole approaches. Neurosurgeons should understand that keyhole mini-craniotomy surgeries aim at "minimally invasive neurosurgery" but still carry the risks of malpractice unless we understand the advantages and disadvantages of these keyhole concepts and strategies.
神经外科手术中的锁孔概念旨在将通向颅内深部病变的手术入路所需的开颅范围降至最低。此类锁孔手术造成的创伤较小，与传统手术技术相比侵入性可能更低。在各种类型的锁孔微骨窗开颅术中，眶上或眶上外侧微骨窗开颅术是标准的基本锁孔入路。眶上外侧锁孔在鞍上至鞍旁区域以及包括前交通动脉复合体的蝶骨平台区域提供了足够的操作空间。尽管神经内镜技术和术中辅助方法有所发展，但锁孔入路的一个主要缺点是操作和观察深部病变的工作角度有限。神经外科医生应明白，锁孔微骨窗开颅手术旨在实现“微创神经外科手术”，但除非我们了解这些锁孔概念和策略的优缺点，否则仍存在医疗失误的风险。
