1Departments of Neurological Surgery and.
3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey.
Neurosurg Focus. 2012 Jan;32 Suppl 1:E2. doi: 10.3171/2012.V2.FOCUS11299.
Retrochiasmatic craniopharyngiomas are formidable cranial base tumors to resect because of their intimate relationship with neighboring critical neurovascular structures, particularly the undersurface of the optic chiasm and hypothalamus. Radical resection offers the best chance of minimizing tumor recurrence, although this may be associated with significant surgical morbidity. Although various transcranial approaches have been utilized (transbasal subfrontal, frontobasal interhemispheric, pterional, orbitozygomatic, and petrosal) for resection of retrochiasmatic craniopharyngiomas, each is associated with some degree of brain retraction, and direct visualization of the retrochiasmatic region is often incomplete, therefore resulting in blind dissection. The endoscopic endonasal transplanum transtuberculum approach provides the most direct route to the retrochiasmatic region while affording unmatched visualization of the undersurface of the optic chiasm, third ventricle, and hypothalamus. This advantage allows for direct bimanual tumor dissection off of these critical structures by using microsurgical principles. The endonasal route also has the advantage of avoiding brain retraction and risk of cerebral edema that can be associated with transcranial approaches. In this operative video atlas report, the authors demonstrate their step-by-step techniques for resection of a suprasellar retrochiasmatic craniopharyngioma using a purely endoscopic endonasal transplanum transtuberculum approach. They describe and illustrate the operative nuances and surgical pearls to safely and efficiently perform the approach, tumor resection, and multilayered reconstruction of the cranial base defect. The video can be found here: http://youtu.be/ZIbJvAyRxYU .
视交叉后颅咽管瘤由于与邻近的关键神经血管结构关系密切，尤其是视交叉和下丘脑的下表面，因此切除起来颇具难度。尽管根治性切除术可能会带来显著的手术并发症，但它能最大限度地降低肿瘤复发的几率。虽然已经采用了各种经颅入路（经颅底额下入路、额底纵裂入路、翼点开颅入路、眶颧入路和岩骨入路）来切除视交叉后颅咽管瘤，但每种入路都伴有一定程度的脑组织牵拉，且对视交叉后区的直接可视化往往不完整，因此导致盲目解剖。经鼻内镜颅底-鞍结节入路为切除视交叉后颅咽管瘤提供了最直接的途径，同时还能提供对视交叉下表面、第三脑室和下丘脑的无与伦比的可视化效果。这一优势允许通过使用显微外科原则直接在这些关键结构上进行双手肿瘤解剖。经鼻入路还具有避免脑牵拉和脑水肿风险的优势，这些风险可能与经颅入路相关。在这个手术视频图谱报告中，作者展示了他们使用纯经鼻内镜颅底-鞍结节入路切除鞍上视交叉后颅咽管瘤的分步技术。他们描述并说明了操作细节和手术要点，以安全有效地进行该入路、肿瘤切除以及颅底缺损的多层重建。该视频可在此处查看：http://youtu.be/ZIbJvAyRxYU。
