Solari Domenico, Morace Roberta, Cavallo Luigi M, Amoroso Francesca, Cennamo Gilda, Del Basso DE Caro Marialaura, Cappabianca Paolo
Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy -
J Neurosurg Sci. 2016 Dec;60(4):454-62. Epub 2016 Jun 7.
Craniopharyngiomas are disembryogenetic, benign, tumors that origin from squamous epithelial remnants of Rathke's pouch, developing from any segment of its course, virtually from rhino-pharynx to the hypothalamus. Historically, different microscopic transcranial routes, have been advocated as possible surgical options for the treatment of craniopharyngiomas. The endonasal technique offers a direct approach that permits access to the suprasellar, retrosellar and retroclival space, obviating brain retraction; it provides the advantage of appraoching cranioopharyngiomas without optic nerve manipulation and/or retraction. We herein present the surgical nuances of the endoscopic endonasal approach for the treatment of craniopharyngiomas, highlighting hints, advantages and drawbacks, also in regards of the anatomy dealt with. The endoscopic endonasal technique has been emerging as a viable approach/alternative for the treatment of this disease as the endoscope itself increased its safety and effectiveness. It allows the removal of both infra and supradiaphragmatic lesions - eventually involving the third ventricle chamber but not extending laterally off the ICA out of the visibility and maneuverability of the instruments - avoiding brain and optic nerve manipulation and retraction, with good visualization of the pituitary gland and stalk and the main neurovascular structures.
颅咽管瘤是胚胎发育异常形成的良性肿瘤，起源于拉克囊的鳞状上皮残余物，可在其行程的任何部位发生，实际上从鼻咽喉到下丘脑均可出现。历史上，不同的显微经颅入路曾被倡导作为治疗颅咽管瘤的可能手术选择。鼻内镜技术提供了一种直接入路，可进入鞍上、鞍后和斜坡后间隙，避免脑牵拉；它具有在不操作和/或牵拉视神经的情况下接近颅咽管瘤的优势。我们在此介绍内镜下鼻内入路治疗颅咽管瘤的手术细节，重点阐述其要点、优势和不足，同时也涉及相关的解剖结构。随着内镜本身安全性和有效性的提高，内镜下鼻内技术已逐渐成为治疗该疾病的一种可行方法/替代方案。它能够切除鞍膈上下的病变——最终可累及第三脑室，但不会超出仪器可视和可操作范围向外侧延伸至颈内动脉——避免脑和视神经的操作与牵拉，能很好地显露垂体和垂体柄以及主要的神经血管结构。
