Microscopic and endoscopic anterior communicating artery complex anatomy as seen through keyhole approaches

The purpose of this anatomical study is to illustrate the microscopic and endoscopic anatomy of the anterior communicating artery complex as viewed through three keyhole approaches (keyhole pterional, lateral supraorbital and supraorbital) and to compare them. Each approach was carried out once on each side in five glutaraldehyde-fixed human cadaveric heads. A microscope and microscope–endoscope combination were used to grade access and visualization of the structures qualitatively using a previously published surgical exposure grading system. All three approaches provided good access and visualization of ipsilateral structures in the anterior communicating artery complex, but the pterional keyhole and the lateral supraorbital approaches gave the best access. Exposure of contralateral structures was limited overall, but was enhanced somewhat by the use of the endoscope.