Minimally invasive keyhole techniques for resection of giant intracranial tumors

Background:While keyhole neurosurgery is increasingly utilized in the operating room,there are few reports regarding the use of keyhole techniques to resect giant intracranial tumors.The feasibility and technique of that were discussed in this paper.Methods:We retrospectively reviewed 95 consecutive patients who were admitted to our service between February 2012 and September 2017 with a maximum intracranial tumor diameter>5 cm.Keyhole approaches were used to resect these tumors in each case,including supraorbital,subtemporal,suboccipital,retromastoid,frontal,temporal,occipital,parietal,pterional,a combined temporo-parietal keyhole approach,and an approach via the longitudinal fissure.Results:We achieved gross total resection in 68/95 cases(71.6%)and subtotal resection in 27/95 cases(28.4%).No surgical death or severe disabilities such as coma and limb dyskinesia occurred following surgery.At the time of discharge,8 patients had complications related to impaired cranial nerve function.In addition,2 patients developed hydrocephalus requiring ventriculo-peritoneal shunt placement,and 4 patients developed a postoperative CSF leak requiring surgical intervention.Conclusion:With meticulous design and reasonable selection,resection of giant intracranial tumors utilizing minimally invasive keyhole approaches can be done safely with satisfactory surgical outcomes.