Cavallo Luigi M, de Divitiis Oreste, Aydin Salih, Messina Andrea, Esposito Felice, Iaconetta Giorgio, Talat Kiris, Cappabianca Paolo, Tschabitscher Manfred
Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
Neurosurgery. 2008 Jun;62(6 Suppl 3):1202-12. doi: 10.1227/01.neu.0000333786.98596.33.
Interest in using the extended endonasal transsphenoidal approach for management of suprasellar lesions, with either a microscopic or endoscopic technique, has increased in recent years. The most relevant benefit is that this median approach permits the exposure and removal of suprasellar lesions without the need for brain retraction.
Fifteen human cadaver heads were dissected to evaluate the surgical key steps and the advantages and limitations of the extended endoscopic endonasal transplanum sphenoidale approach. We compared this with the transcranial microsurgical view of the suprasellar area as explored using the bilateral subfrontal microsurgical approach, and with the anatomy of the same region as obtained through the endoscopic endonasal route.
Some anatomic conditions can prevent or hinder use of the extended endonasal approach. These include a low level of sphenoid sinus pneumatization, a small sella size with small distance between the internal carotid arteries, a wide intercavernous sinus, and a thick tuberculum sellae. Compared with the subfrontal transcranial approach, the endoscopic endonasal approach offers advantages to visualizing the subchiasmatic, retrosellar, and third ventricle areas.
The endoscopic endonasal transplanum sphenoidale technique is a straight, median approach to the midline areas around the sella that provides a multiangled, close-up view of all relevant neurovascular structures. Although a lack of adequate instrumentation makes it impossible to manage all structures that are visible with the endoscope, in selected cases, the extended endoscopic endonasal approach can be considered part of the armamentarium for surgical treatment of the suprasellar area.
近年来，无论是采用显微镜技术还是内镜技术，使用扩大经鼻蝶窦入路治疗鞍上病变的关注度都有所增加。最显著的益处在于，这种经中线入路能够在无需牵拉脑组织的情况下暴露并切除鞍上病变。
解剖15个尸头，以评估扩大经鼻内镜经蝶骨平台入路的手术关键步骤及其优缺点。我们将其与经双侧额下入路的鞍上区经颅显微手术视野以及经鼻内镜入路所获得的同一区域的解剖结构进行了比较。
某些解剖条件可能会妨碍或阻止使用扩大经鼻入路。这些条件包括蝶窦气化程度低、蝶鞍小且颈内动脉间距小、海绵间窦宽以及鞍结节厚。与额下经颅入路相比，经鼻内镜入路在观察视交叉下、鞍后及第三脑室区域方面具有优势。
经鼻内镜经蝶骨平台技术是一种直达蝶鞍周围中线区域的经中线入路，可提供所有相关神经血管结构的多角度特写视野。尽管缺乏足够的器械使得无法处理内镜下可见的所有结构，但在特定病例中，扩大经鼻内镜入路可被视为鞍上区手术治疗手段的一部分。
