Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
Eur Arch Otorhinolaryngol. 2010 May;267(5):649-63. doi: 10.1007/s00405-009-1196-0. Epub 2010 Jan 9.
Endoscopic techniques have undergone tremendous advancement in the past years. From the management of phlogistic pathologies, we have learned to manage skull base lesions and even selected intracranial diseases. Current anatomical knowledge plus computer-aided surgery has enabled surgeons to remove large lesions in the paranasal sinuses extending beyond the boundaries of the sinuses themselves. In this sense, management of benign diseases via endoscopic routes is nowadays well accepted whilst the role of endoscopic techniques in sinonasal malignancies is still under investigation. Nowadays, it is possible to tackle different pathologies placed not only in the ventral skull base, but also extended laterally (infratemporal fossa and petrous apex) and even, in really selected cases, within the orbit. The ability to resect and reconstruct has improved significantly. At the moment, the improvement in surgical techniques, like the four-handed technique, has rendered endoscopic procedures capable of managing complex pathologies, according the same surgical principles of the open approaches. From now onwards, frameless neuronavigation, modular approaches, intraoperative imaging systems and robotic surgery are and will be an increasingly important part of endonasal surgery, and they will be overtaken by further evolution.
近年来，内镜技术取得了巨大的进步。从炎症性疾病的治疗，我们已经学会了治疗颅底病变，甚至是一些颅内疾病。目前的解剖学知识加上计算机辅助手术，使外科医生能够切除鼻窦内延伸至鼻窦本身边界以外的大病变。从这个意义上讲，通过内镜途径治疗良性疾病现在已被广泛接受，而内镜技术在鼻旁窦恶性肿瘤中的作用仍在研究之中。如今，不仅可以治疗位于颅底前部的不同疾病，还可以治疗颅底侧面（颞下窝和岩尖）的疾病，甚至在非常特定的情况下，还可以治疗眼眶内的疾病。切除和重建的能力显著提高。目前，手术技术的改进，如四手操作技术，使得内镜手术能够根据开放式手术的相同手术原则来治疗复杂的疾病。从现在开始，无框架神经导航、模块化方法、术中成像系统和机器人手术将成为和继续成为鼻内镜手术的重要组成部分，并将随着进一步的发展而被取代。
