Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, People's Republic of China.
Acta Neurochir (Wien). 2011 Jan;153(1):12-8. doi: 10.1007/s00701-010-0852-x. Epub 2010 Nov 8.
The endoscopic expanded endonasal approach (EEA) has been reported in literature as a useful tool to treat sellar, parasellar, suprasellar, and clival lesions. The endoscope permits a panoramic view rather than a narrow microscopic view, and this approach can reach the lesion without brain retraction and with minimal neurovascular manipulation. However, because of the narrow corridor, the preoperative evaluation of the lesions should be of high priority. 3D fast-imaging employing steady-state acquisition (3D-FIESTA) or constructive interference in steady state (CISS) MR imaging provides high spatial resolution in the small structures within the cisterns. Therefore, this technique may be useful for better preoperative planning in detecting optic nerve, oculomotor nerve, chiasma, infundibulum, pituitary stalk, and small vessels in sellar region. Here we used the 3D-FIESTA MR images to evaluate EEA for seven midline skull-base lesions. Our report showed that, when EEA was used to treat midline skull-base lesions, 3D-FIESTA MR images were valuable in the assessment of vital structures in and around the tumor-involved midline skull-base region. 3D-FIESTA MR images can help in making a better preoperative planning, locating the intraoperative structures, and reducing the surgical risks. Otherwise, this approach is helpful for the craniopharyngioma classification based on EEA.
内镜经扩大鼻内入路（EEA）已在文献中被报道为一种治疗鞍区、鞍旁、鞍上和斜坡病变的有用工具。内镜允许全景视图，而不是狭窄的显微镜视图，并且这种方法可以到达病变部位，而无需脑牵拉，并且对神经血管的操作最小。然而，由于狭窄的通道，病变的术前评估应该是重中之重。3D 快速成像采用稳态采集（3D-FIESTA）或稳态下的建设性干扰（CISS）MR 成像在池内的小结构中提供高空间分辨率。因此，该技术可能有助于更好地进行术前规划，以检测视神经、动眼神经、视交叉、漏斗、垂体柄和鞍区的小血管。在这里，我们使用 3D-FIESTA MR 图像评估了 7 例中线颅底病变的 EEA。我们的报告表明，当 EEA 用于治疗中线颅底病变时，3D-FIESTA MR 图像对于评估肿瘤累及的中线颅底区域内和周围的重要结构非常有价值。3D-FIESTA MR 图像有助于制定更好的术前计划、定位术中结构和降低手术风险。否则，这种方法有助于基于 EEA 的颅咽管瘤分类。
