Effendi Sabih T, Rao Vikas Y, Momin Eric N, Cruz-Navarro Jovany, Duckworth Edward A M
Departments of Neurological Surgery and.
J Neurosurg. 2014 Dec;121(6):1446-52. doi: 10.3171/2014.8.JNS132609. Epub 2014 Sep 26.
The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach.
Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma.
Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm(2) ± 360 mm(2) vs 2045 mm(2) ± 352 mm(2), respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically.
The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.
经基底入路（TBA）是一种前颅底入路，可用于显露前颅底、鞍区-鞍上区域及斜坡。TBA通常包括分两步进行的双额开颅术及眶缘和/或鼻骨截骨术。作者通过一项定量尸体解剖研究探讨了一次性完成该入路的可行性，并展示了其手术方法的一个病例实例。
对7个注入乳胶的尸体头部进行一次性TBA，然后进行传统两步法典型的额外去骨操作。在额外去骨前后测量相对于垂体柄的6个手术角度以及眶顶截骨的表面积。在所有标本中测量从前鼻缝到盲孔的垂直角度。除了解剖学研究外，作者还在手术室中使用了该技术，并展示了一例前颅底脑膜瘤切除术的病例。
形态学测量结果如下：从前鼻缝到盲孔的垂直角度向上范围为17.4°至29.7°（平均23.8°±4.8°）。在6个手术角度测量中，与一次性入路相比，两步法入路仅中间水平角度增加（分别为平均43.4°±4.6°和43.0°±4.3°；p = 0.049），平均增加0.4°。与一次性入路相比，两步法入路眶截骨面积增加（分别为平均2467 mm²±360 mm²和2045 mm²±352 mm²；p <0.001）。在典型临床病例中，患者在临床和美容方面均取得了良好效果。
一次性TBA为传统两步法入路提供了一种替代方法。它便于更轻松地重建，可能缩短手术时间，并改善美容效果。虽然两步法可去除更多眶顶骨质，但额外的骨质去除仅使所测量的6个手术角度之一略有增加。
