Acta Neurochirurgica

, Volume 158, Issue 4, pp 703–710 | Cite as

Comparison of surgical exposure and maneuverability associated with microscopy and endoscopy in the retrolabyrinthine and transcrusal approaches to the retrochiasmatic region: a cadaveric study

  • Jie Yang
  • Fang Zhang
  • Aiguo Xu
  • Huadong Li
  • Zihai DingEmail author
Technical Note - Neurosurgical Anatomy



The retrolabyrinthine and transcrusal approaches (RLA and TCA, respectively) are the two most often used posterior transpetrosal approaches that are used to treat lesions in the retrochiasmatic region. Endoscopes are increasingly used in neurosurgical practice. To determine whether a difference exists between the two transpetrosal approaches in the retrochiasmatic region, we evaluated and compared the exposure and maneuverability associated with the microscope and the endoscope in these approaches.


Seven formalin-fixed cadaveric heads were dissected bilaterally through the two approaches: four for evaluation and three injected with colored latex for photography. The retrochiasmatic region was divided into four sub-compartments: the compartment before the infundibulum, which was further divided into two parts, (1) the ipsilateral and (2) the contralateral compartments; (3) the retroinfundibulum compartment; (4) the third ventricle. After each approach, exposure and maneuverability of the structures in these four compartments obtained by microscopy and endoscopy were scored under a guidance of a numerical grading system for further comparison.


The TCA provided better exposure and maneuverability at the retrochiasmatic region than the RLA in both the microscopy model [scores of 39.75 ± 2.12 and 32.38 ± 2.56 respectively (p < 0.05)] and the endoscopy model [scores of 82.13 ± 3.40 and 43.75 ± 1.67 respectively (p < 0.05)].


The TCA is better than the RLA at offering exposure and manipulation to structures in the retrochiasmatic region, especially in patients whose lesion is located high into the third ventricle and/or expanded into the contralateral part. Endoscopes may be helpful in TCA in terms of exposing and maneuvering structures in the contralateral and interpeduncle fossa areas. However, in RLA, not enough room is available for simultaneously maneuvering an endoscope and a surgical instrument.


Retrochiasmatic region Posterior transpetrosal approach Transcrusal approach Retrolabyrinthine approach Endoscopy 


Compliance with ethical standards


No funding was received for this research.

Conflicts of interest

All authors certify that they have no affiliations with any organization with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures in this study were performed in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

This study included no individual participant.


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Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Jie Yang
    • 1
  • Fang Zhang
    • 2
  • Aiguo Xu
    • 3
  • Huadong Li
    • 4
  • Zihai Ding
    • 1
    Email author
  1. 1.Institute of Minimal Invasive Surgical Anatomy, Department of Anatomy, School of Basic Medicine ScienceSouthern Medical UniversityGuangzhouChina
  2. 2.Department of OtolaryngologyThe Third Affiliated Hospital of Southern Medical UniversityGuangzhouChina
  3. 3.Department of Otolaryngology, The First College of Clinical Medical ScienceChina Three Gorges University & Yichang Central People’s HospitalYichangChina
  4. 4.Department of NeurosurgeryLingyi People’s HospitalLingyiChina

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