Zwagerman Nathan T, Zenonos Georgios, Lieber Stefan, Wang Wei-Hsin, Wang Eric W, Fernandez-Miranda Juan C, Snyderman Carl H, Gardner Paul A
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Neurooncol. 2016 Nov;130(2):319-330. doi: 10.1007/s11060-016-2274-y. Epub 2016 Oct 20.
The endoscopic endonasal approach (EEA) has significantly evolved since its initial uses in pituitary and sinonasal surgery. The literature is filled with reports and case series demonstrating efficacy and advantages for the entire ventral skull base. With competence in 'minimally invasive' parasellar approaches, larger and more complex approaches were developed to utilize the endonasal corridor to create maximally invasive endoscopic skull base procedures. The challenges of these more complex endoscopic procedures include a long learning curve and navigating in a narrow corridor; reconstruction of defects presented new challenges and early experience revealed a significantly higher risk of cerebrospinal fluid leak. Despite these challenges, there are many benefits to the EEA including avoidance of brain and neurovascular retraction, improved visualization, a direct corridor onto many tumors and the two-surgeon approach. Most importantly, the EEA provides a midline corridor to directly access tumors, which displace critical neurovascular structures laterally, giving it an inherent advantage of minimizing any manipulation of these structures and thus decreasing their potential injury.
自最初应用于垂体和鼻窦手术以来，鼻内镜鼻内入路（EEA）有了显著发展。文献中充斥着各种报告和病例系列，证明了其对整个腹侧颅底手术的有效性和优势。随着在“微创”鞍旁入路方面能力的提升，人们又开发出更大、更复杂的入路，利用鼻内通道开展最大程度的侵入性内镜颅底手术。这些更复杂的内镜手术面临的挑战包括学习曲线长以及在狭窄通道中操作；缺损修复带来了新的挑战，早期经验显示脑脊液漏的风险显著更高。尽管存在这些挑战，EEA仍有诸多益处，包括避免牵拉脑和神经血管、改善视野、提供直达许多肿瘤的通道以及双术者操作方式。最重要的是，EEA提供了一条中线通道，可直接进入那些将关键神经血管结构向外侧推移的肿瘤，这使其具有将对这些结构的任何操作减至最少从而降低其潜在损伤的固有优势。
