Endoscopic extended transsphenoidal resection of craniopharyngiomas: nuances of neurosurgical technique

颅咽管瘤 第三脑室 医学 内窥镜 外科 视交叉 切除术 揭穿 内窥镜检查 海绵窦 计算机科学 视神经 解剖 癌症 内科学 卵巢癌
作者
Andrew Conger,M.S.,Joshua Lucas,Gabriel Zada,Theodore H. Schwartz,Aaron Cohen‐Gadol
出处
期刊:Neurosurgical Focus [Journal of Neurosurgery Publishing Group]
卷期号:37 (4): E10-E10 被引量:56
标识
DOI:10.3171/2014.7.focus14364
摘要

Endoscopic approaches to the midline ventral skull base have been extensively developed and refined for resection of cranial base tumors over the past several years. As these techniques have improved, both the degree of resection and complication rates have proven comparable to those for transcranial approaches, while visual outcomes may be better via endoscopic endonasal surgery and hospital stays and recovery times are often shorter. Yet for all of the progress made, the steep learning curve associated with these techniques has hampered more widespread implementation and adoption. The authors address this obstacle by coupling a thorough description of the technical nuances for endoscopic endonasal craniopharyngioma resection with detailed illustrations of the important steps in the operation. Traditionally, transsphendoidal approaches to craniopharyngiomas have been restricted to lesions mostly confined to the sella. However, recently, endoscopic endonasal resections are more frequently employed for extrasellar and purely third ventricle craniopharyngiomas, whose typical retrochiasmatic location makes them ideal candidates for endoscopic transnasal surgery. The endonasal endoscopic approach offers many advantages, including direct access to the long axis of the tumor, early tumor debulking with minimal manipulation of the optic apparatus, more precise visualization of tumor planes, particularly along the undersurface of the chiasm and the roof of the third ventricle, and a minimal-access corridor that obviates the need for brain retraction. Although much emphasis has been placed on technical tenets of exposure and “how to get there,” this article focuses on nuances of tumor resection “when you are there.” Three operative videos illustrate our discussion of technical tenets.
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