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:E3. doi: 10.3171/2012.V3.FOCUS11300.
Anterior skull base (ASB) schwannomas are extremely rare and can often mimic other pathologies involving the ASB such as olfactory groove meningiomas, hemangiopericytomas, esthesioneuroblastomas, and other malignant ASB tumors. The mainstay of treatment for these lesions is gross-total resection. Traditionally, resection for tumors in this location is performed through a bifrontal transbasal approach that can involve some degree of brain retraction or manipulation for tumor exposure. With the recent advances in endoscopic skull base surgery, various ASB tumors can be resected successfully using an expanded endoscopic endonasal transcribriform approach through a "keyhole craniectomy" in the ventral skull base. This approach represents the most direct route to the anterior cranial base without any brain retraction. Tumor involving the paranasal sinuses, medial orbits, and cribriform plate can be readily resected. In this video atlas report, the authors demonstrate their step-by-step techniques for resection of an ASB olfactory schwannoma using a purely endoscopic endonasal transcribriform 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/NLtOGfKWC6U .
前颅底 (ASB) 神经鞘瘤极为罕见，常可模拟 ASB 中的其他病变，如嗅沟脑膜瘤、血管外皮细胞瘤、嗅神经母细胞瘤和其他恶性 ASB 肿瘤。这些病变的主要治疗方法是大体全切除。传统上，该部位肿瘤的切除通过额骨切开额下入路进行，可能需要一定程度的脑牵拉或操作以暴露肿瘤。随着内镜颅底外科的最新进展，各种 ASB 肿瘤可通过扩大的内镜经鼻内筛板入路，通过颅底腹侧的“锁孔颅骨切开术”成功切除。该入路是到达前颅底的最直接途径，无需任何脑牵拉。累及鼻窦、内侧眶和筛板的肿瘤可被轻易切除。在这个视频图谱报告中，作者展示了他们使用纯粹的内镜经鼻内筛板入路切除 ASB 嗅鞘瘤的分步技术。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、肿瘤切除和颅底缺损的多层重建。视频可在此处找到：http://youtu.be/NLtOGfKWC6U。
