1. What is Keyhole technique in Neurosurgery?
Keyhole neurosurgery is defined as brain surgery done by making a small bone window approximately 2 cm in diameter over skull bone. It is also known as Minimally Invasive surgery. It aids the neurosurgeon avoid damage to surrounding tissues and therefore potentially lowering complications.
2. Is Keyhole surgery meant for cosmetic reasons only?
The main concept behind Keyhole surgery is to minimise patient’s morbidity and decrease handling of the brain during surgery. Keyhole surgery helps in making a small incision in the skull bone. And therefore it has a good cosmetic outcome too.
3. How Keyhole Craniotomy came into effect in Neurosurgery?
Initially due to non-availability of microscope, endoscope and other advanced instruments, neurosurgeon used to make bigger openings in the skull and do brain surgery. But now with new advanced instruments, it is now possible to do brain surgery with a small opening in skull bone. The concept came in to being in 1971 when Dr Donald H Wilson (Neurosurgeon) put forward the concept of Keyhole Surgery.
4. What types of brain surgery can be done with Keyhole Craniotomy?
Intracranial brain tumor, Intra-ventricular tumor, Aneurysm clipping, AVM excision, and Intra-cranial haematoma evacuation procedures can be done. It is normally the tumor’s characteristics that decides the surgical approach to be taken. The Neurosurgery Dept at KIMS Hospitals, Secunderabad has been at the forefront at performing Keyhole surgeries for various brain tumors and other brain diseases regularly.
5. What instruments are used in Keyhole Craniotomy?
Microscope, Neuroendoscopy, Neuronavigation and Neuro robotic system helps in better performance of Keyhole brain surgery.
6. What are the advantage of Keyhole Neurosurgery?
The advantages of this operation include better cosmetic results, quick rehabilitation; minimal brain exposure and iatrogenic traumatization, which decrease the risk of postoperative complications such as Epilepsy, Infection, Haemorrhage, etc. Direct approach shortens the duration of open and closure procedures and helps the surgeon to focus their attention on manipulation of intracranial lesions; less worry about operation, more confidence in healing, early physical recovery, short hospital stay and less nursing burden.
7. What care has to be followed during selection for Keyhole Neurosurgery?
Keyhole Neuro microsurgery should comprise in-depth understanding of individual lesions and their anatomy, adequate evidence from neuroimaging, other examinations, deliberated designs of approaches, proper & effective perioperative management, advanced surgical instruments & devices, excellent microsurgical skills and sound clinical experience.
Sr. Consultant Neurosurgery, KIMS Hospitals