Endoscopic endonasal transsphenoidal surgery
Endoscopic endonasal transsphenoidal surgery
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DOI：
10.1227/01.neu.0000137330.02549.0d
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发表时间：
2004-10-01
期刊：
影响因子：
4.8
通讯作者：
de Divitiis, E
中科院分区：
文献类型：
--
作者：
Cappabianca, P;Cavallo, LM;de Divitiis, E
内窥镜鼻内经蝶入路是一种用于切除鞍区和鞍旁病变的微创手术技术。该手术通过前蝶窦切开术进行。与标准显微外科手术相比，内窥镜入路的两个主要特征是使用内窥镜作为独特的光学装置和没有经蝶窦牵开器。采用更方便的直手术器械，而刺刀形工具用于显微外科手术，以避免与显微镜产生的光束的任何干扰。标准手术技术由三个主要时间阶段组成：鼻期、蝶骨期和鞍期。在鼻期，内窥镜通过选定的鼻孔进入，并前进到蝶筛隐窝，在此处进行蝶窦切开术。蝶窦期包括从蝶喙分离鼻中隔、前蝶窦切开术、去除蝶窦中隔或中隔以及识别蝶窦内的标志。在鞍阶段，进行鞍底的打开以去除病变。通过成角镜获得鞍区环境的宽视野，以检测最终的肿瘤残留。手术以重建蝶鞍和从鼻孔中取出内窥镜结束，没有任何术后鼻腔填塞。
THE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL approach is a minimally invasive surgical technique for the removal of sellar and parasellar lesions. The procedure is performed via an anterior sphenoidotomy. The two main characteristics of the endoscopic approach, when compared with the standard microsurgical operation, arise from the use of the endoscope as a unique optical device and from the absence of a transsphenoidal retractor. More convenient straight surgical instruments are employed, whereas bayonet-shaped tools are used in the microsurgical procedure, to avoid any interference with the light beam generated by the microscope. The standard surgical technique is composed of three main time phases: the nasal, sphenoid, and sellar phase. During the nasal phase, the scope is introduced through the chosen nostril and advanced up to the sphenoethmoid recess, where the sphenoidotomy is performed. The sphenoid phase consists of the detachment of the nasal septum from the sphenoid rostrum, the anterior sphenoidotomy, removal of the sphenoid septum or septa, and identification of the landmarks inside the sphenoid sinus. In the sellar phase, an opening of the sellar floor is performed for removal of the lesion. A wide view of the sellar environment is obtained through angled scopes to detect eventual tumor remnants. The procedure ends with the reconstruction of the Sella and removal of the endoscope from the nostril, without any postoperative nasal packing.