Davanzo Justin R, Goyal Neerav, Zacharia Brad E
Department of Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States.
Department of Surgery, Division of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States.
J Neurol Surg B Skull Base. 2018 Feb;79(2):S194-S195. doi: 10.1055/s-0038-1623524. Epub 2018 Jan 23.
This video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma. To facilitate robust skull base repair, a vascularized nasoseptal flap was harvested. A wide sphenoidotomy was performed and the sella and tuberculum were exposed. After the dural opening and arachnoid dissection, the stalk was identified, merging seamlessly with the tumor capsule. The lesion was then internally debulked with the use of an ultrasonic aspirator. The capsule was then dissected off of the optic chiasm, thalamus, and hypothalamus. The cavity was inspected with an angled endoscope to ensure complete resection. A multilayered reconstruction was performed using autologous fascia lata, the previously harvested nasoseptal flap, and dural sealant. Postoperatively, the patient did have expected panhypopituitarism but remained neurologically intact and had improvement in his vision. In conclusion, this video demonstrates how an expanded endonasal approach can be used to safely resect a craniopharyngioma, even when in close proximity to delicate structures such as the optic chiasm. The link to the video can be found at: https://youtu.be/tahjHmrXhc4 .
这段视频摘要展示了扩大经鼻内镜入路在切除视交叉后颅咽管瘤中的应用。这些肿瘤治疗难度极大，人们尝试了多种方法以实现安全有效的切除。经鼻内镜入路已越来越多地用于特定的鞍区/鞍上病变。我们报告一例39岁男性病例，该患者被发现患有囊性、部分钙化的鞍上肿块，符合颅咽管瘤表现。为便于进行可靠的颅底修复，切取了带血管蒂的鼻中隔瓣。进行了广泛的蝶窦切开术，暴露了鞍底和鞍结节。打开硬脑膜并进行蛛网膜分离后，识别出肿瘤蒂，其与肿瘤包膜无缝融合。然后使用超声吸引器对病变进行瘤内减压。接着将肿瘤包膜从视交叉、丘脑和下丘脑上剥离。用成角内镜检查术腔以确保完全切除。使用自体阔筋膜、先前切取的鼻中隔瓣和硬脑膜封闭剂进行了多层重建。术后，患者出现了预期的全垂体功能减退，但神经功能保持完整，视力有所改善。总之，本视频展示了扩大经鼻内镜入路如何能够安全地切除颅咽管瘤，即使肿瘤紧邻视交叉等精细结构。视频链接可在以下网址找到：https://youtu.be/tahjHmrXhc4 。
