Louis Robert G, Eisenberg Amy, Barkhoudarian Garni, Griffiths Chester, Kelly Daniel F
Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, United States.
Int Arch Otorhinolaryngol. 2014 Oct;18(Suppl 2):S136-48. doi: 10.1055/s-0034-1395265.
Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach. Paralleling the evolution of the endonasal route to the parasellar region, the supraorbital eyebrow craniotomy has also been increasingly used as an alternative minimally invasive approach to reach this skull base region. Similar to the endonasal route, the supraorbital route has been greatly facilitated by advances in endoscopy, along with development of more refined, low-profile instrumentation and surgical navigation technology. Objectives This review, encompassing both transcranial and transsphenoidal routes, will recount the high points and advances that have made minimally invasive approaches to the sellar region possible, the evolution of these approaches, and their relative indications and technical nuances. Data Synthesis The literature is reviewed regarding the evolution of surgical approaches to the sellar region beginning with the earliest attempts and emphasizing technological advances, which have allowed the evolution of the modern technique. The surgical techniques for both endoscopic transsphenoidal and supraorbital approaches are described in detail. The relative indications for each approach are highlighted using case illustrations. Conclusions Although tremendous advances have been made in transitioning toward minimally invasive transcranial and transsphenoidal approaches to the sella, further work remains to be done. Together, the endonasal endoscopic and the supraorbital endoscope-assisted approaches are complementary minimally invasive routes to the parasellar region.
鉴于内镜图像质量、器械、手术导航、颅底闭合技术以及解剖学认识方面的进展，经鼻内镜入路已迅速发展成为一种广泛应用于切除鞍区和鞍旁肿瘤的技术。尽管垂体腺瘤和拉克氏囊肿是通过该途径切除的大多数病变，但颅咽管瘤、斜坡脊索瘤、鞍旁脑膜瘤和其他病变越来越多地采用这种方法切除。与经鼻入路至鞍旁区域的发展并行，眶上眉弓开颅术也越来越多地被用作到达该颅底区域的另一种微创方法。与经鼻入路类似，内镜技术的进步以及更精细、外形小巧的器械和手术导航技术的发展极大地促进了眶上入路的应用。
本综述涵盖经颅和经蝶窦途径，将叙述使鞍区微创入路成为可能的要点和进展、这些入路的演变及其相对适应证和技术细节。
回顾了有关鞍区手术入路演变的文献，从最早的尝试开始，并强调技术进步，这些进步促成了现代技术的发展。详细描述了内镜经蝶窦和眶上入路的手术技术。通过病例说明突出了每种入路的相对适应证。
尽管在向鞍区微创经颅和经蝶窦入路的转变方面已经取得了巨大进展，但仍有进一步的工作要做。经鼻内镜和眶上内镜辅助入路共同构成了通往鞍旁区域的互补性微创途径。
