Optical Retractor for Endoscopically Assisted Collection a. Temporalis Superficialis and Cranioplasty

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The optical retractor is an endoscopic system originally designed for endoscopic facial reconstruction. We have developed two new minimally invasive neurosurgical techniques using an optical retractor. With its help, a subcutaneous space is created, which is constantly monitored using connected optics. The non-leading hand holds the retractor, while the dominant hand operates in the subcutaneous space with specially designed surgical instruments.

1. Endoscopically assisted a collection of the superficial temporal artery (a. temporalis superficialis).
   A 7 cm long incision is made along the parietal branch of the superficial temporal artery. After exposure of the parietal branch, access to the frontal branch is created through an incision using an optical retractor with 4 mm optics connected. The frontal branch of the superficial temporal artery 6-8 cm in length is removed subcutaneously under endoscopic control. The anastomosis is applied between the two branches of the superficial temporal artery and the middle cerebral artery (a. cerebri media); for this purpose, a small craniotomy is performed using a through incision.
   Our experience shows that the superficial temporal artery can be removed utilizing a small through incision remote from the artery. In this way, postoperative scalp necrosis and hair loss can be avoided. This less invasive technique expands the use of the superficial temporal artery in revascularization surgery, taking into account the limitations caused by the anatomical course of the artery
2. Endoscopically assisted cranioplasty for pterional bone defect after frontotemporal craniotomy. A preliminary incision 3 cm long, in the hair growth zone, dorsally from the bone defect, is opened under local anesthesia. The preparation area is created under the temporal muscle (m. temporalis) or periosteum. The intermediate space is kept free by lifting the tissue with an optical retractor. Dissection is performed in the pterional region under direct endoscopic control. With the help of elevators, dissectors, and scissors, the scalp is separated from the dura mater until the edge of the bone near the defect is exposed. If the edge of the bone is covered with a crusty layer (kortikalis), then it should be sanded with a bur. After hemostasis, using targeted bipolar electrocautery, the prepared paste of calcium phosphate cement is injected with a syringe into the bone defect and modeled with a spatula. After the material has hardened (after 20-30 minutes), the wound is closed. On the night after the operation, suction drainage is applied subcutaneously.
   Our endoscopic cranioplasty technique for small bone defects (3x3 cm to 5x5 cm) is simple and easy to perform. This minimally invasive method is especially beneficial for patients suffering from disfiguring changes as a result of frontotemporal craniotomy.