Neuroendoscopic transnasal surgery for skull base tumors: basic approaches, avoidance of pitfalls, and recent innovations.
Neuroendoscopic transnasal surgery for skull base tumors: basic approaches, avoidance of pitfalls, and recent innovations.
复制标题
颅底肿瘤的神经内窥镜经鼻手术：基本方法、避免陷阱和最新创新。
DOI：
10.2176/nmc.52.697
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发表时间：
2012
影响因子：
1.9
通讯作者：
N. Saito
中科院分区：
文献类型：
--
作者：
M. Shin;K. Kondo;N. Saito
自从内窥镜技术引入神经外科领域以来，经鼻手术的作用已经显著扩大。通过这种技术，我们可以进入前颅底、鞍旁区、斜坡、海绵窦和颅颈交界处，比传统的显微手术创伤更小。本文就内窥镜颅底手术的两种主要入路，即经鼻入路和经中隔入路作一综述。经鼻入路使用两个鼻孔，无需鼻镜，并去除蝶喙和鼻中隔后缘的粘膜。在经中隔入路中，只有一个鼻孔是可用的，但使用鼻镜，可以获得足够的手术野，只有一个小切口的鼻中隔。在任何一种入路方法中，避免过度的粘膜损伤并为每位患者选择合适的入路非常重要。内窥镜颅底入路是一种创伤最小的手术方法，是一种非常有前途的治疗选择，具有进一步发展的潜力。为了获得更好的手术效果并取得进一步进展，与鼻喉科医生的合作至关重要，因为鼻喉科医生比神经外科医生对鼻手术的知识和经验要多得多。我们相信这篇文章将有助于发展安全有效的外科手术方法，并为患有难治性颅底病变的患者带来益处。
Since the introduction of endoscopic technology in the neurosurgical field, the role of transnasal surgery has been dramatically enlarged. With this technique, we can approach the anterior cranial base, parasellar region, clivus, cavernous sinus, and craniovertebral junction, less invasively than with conventional microsurgery. This review describes the two major approach methods in endoscopic skull base surgery, the endonasal approach and the transseptal approach. The endonasal approach uses two nostrils without nasal specula and the mucosa on the sphenoid rostrum and the posterior margin of the nasal septum are removed. In the transseptal approach, only a single nostril is available, but using the nasal speculum, sufficient surgical field can be obtained with only a small incision on the septum. In either approach method, it is very important to avoid excessive mucosal damage and to select the appropriate approach for each patient. The endoscopic skull base approach is one of the least invasive surgical procedures, which is a very promising therapeutic choice with potential for further advances. For better surgical outcomes and further progress, cooperation with rhinolaryngologists who have much more knowledge and experience about nasal surgery than neurosurgeons is essential. We believe this article will contribute to the development of safe and effective surgical procedures, and to the benefit of the patients suffering with intractable skull base lesions.