Oyama Kenichi, Tahara Shigeyuki, Hirohata Toshio, Ishii Yudo, Prevedello Daniel M, Carrau Ricardo L, Froelich Sebastien, Teramoto Akira, Morita Akio, Matsuno Akira
Department of Neurosurgery, Pituitary & Endoscopic Surgery Center, Teikyo University School of Medicine.
Department of Neurological Surgery, Nippon Medical School.
Neurol Med Chir (Tokyo). 2017 Oct 15;57(10):534-541. doi: 10.2176/nmc.ra.2017-0039. Epub 2017 Aug 25.
The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel's cave, parapharyngeal space, infratemporal fossa, etc. To gain access to the upper lateral skull base, a simple opening of the ethmoid sinus provides sufficient exposure of this area. To reach the lower lateral skull base, a transpterygoid approach, following ethmoidectomy, is a key procedure providing wide exposure of this area. Understanding of surgical anatomy is mandatory for treating ventrolateral skull base lesions via EEA. An appropriate, less-invasive approach should be applied depending on the size, location, and type of lesion.
作者描述了经鼻内镜入路（EEA）至颅底腹外侧的手术解剖结构。颅底腹外侧可分为两个部分：上外侧颅底和下外侧颅底。上外侧颅底包括海绵窦和眼眶，而下外侧颅底包括岩尖、梅克尔腔、咽旁间隙、颞下窝等。要进入上外侧颅底，单纯打开筛窦即可充分暴露该区域。要到达下外侧颅底，在筛窦切除术后采用经翼突入路是关键步骤，可广泛暴露该区域。对于经EEA治疗颅底腹外侧病变而言，了解手术解剖结构是必不可少的。应根据病变的大小、位置和类型采用合适的、侵入性较小的入路。
