Schwartz Theodore H, Fraser Justin F, Brown Seth, Tabaee Abtin, Kacker Ashutosh, Anand Vijay K
Department of Neurological Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York 10021, USA.
Neurosurgery. 2008 May;62(5):991-1002; discussion 1002-5. doi: 10.1227/01.neu.0000325861.06832.06.
Endoscopic cranial base surgery is a minimal access, maximally aggressive alternative to traditional transfacial, transcranial, or combined open cranial base approaches. Previous descriptions of endoscopic approaches have used varying terminology, which can be confusing to the new practitioner. Indications for surgery are not well defined. Our objective was to create a comprehensive classification system of the various approaches and describe their indications with case examples.
We prospectively compiled a comprehensive database of our endonasal endoscopic operations, detailing the nasal sinus transgressed, the cranial base approach, and the intracranial target for the first 150 consecutive cases performed at our institution. All cases were performed collaboratively by a neurosurgeon and an otolaryngologist.
We categorized the endonasal endoscopic cranial base operations into four nasal corridors, nine cranial base approaches, and 13 intracranial targets. Each of the various approaches is described in detail and illustrated with case examples. Pathology encountered included pituitary tumor (50%), meningocele/encephalocele (14%), craniopharyngioma and Rathke cleft cyst (10%), meningioma (8%), chordoma (5%), esthesioneuroblastoma (2%), and other (11%).
Endonasal endoscopic cranial base surgery is a minimal access, maximally invasive alternative to open transcranial cranial base approaches for specific indications. A clear understanding of the possible approaches is facilitated by an awareness of the nasal corridors and intracranial targets.
内镜颅底手术是一种微创、积极的手术方式，可替代传统的经面部、经颅或联合开放颅底手术入路。以往关于内镜手术入路的描述使用了不同的术语，这可能会让新从业者感到困惑。手术适应证也没有明确界定。我们的目的是创建一个各种手术入路的综合分类系统，并用病例实例描述其适应证。
我们前瞻性地汇编了一个关于鼻内镜手术的综合数据库，详细记录了在我们机构连续进行的前150例手术中所涉及的鼻窦、颅底手术入路和颅内靶点。所有病例均由神经外科医生和耳鼻喉科医生共同完成。
我们将鼻内镜颅底手术分为四个鼻腔通道、九种颅底手术入路和13个颅内靶点。对各种手术入路均进行了详细描述，并配有病例实例说明。所遇到的病理情况包括垂体瘤（50%）、脑膜膨出/脑膨出（14%）、颅咽管瘤和拉克囊肿（10%）、脑膜瘤（8%）、脊索瘤（5%）、嗅神经母细胞瘤（2%）以及其他（11%）。
对于特定适应证，鼻内镜颅底手术是一种微创、侵入性最大的替代开放经颅颅底手术入路的方法。了解鼻腔通道和颅内靶点有助于清晰理解可能的手术入路。
