Liu James K, Watanabe Kentaro
Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey.
J Neurol Surg B Skull Base. 2018 Feb;79(2):S213-S214. doi: 10.1055/s-0037-1606553. Epub 2017 Nov 1.
The optimal approach for surgical resection of tuberculum sellae meningiomas remains controversial. Approach selection is largely based on a variety of factors, such as tumor size, extent and location relative to the optic canal and internal carotid artery, the presence of vascular encasement, and surgeon's preference. In this operative video manuscript, the authors demonstrate the importance of an open transcranial approach when the tumor extends lateral to the optic nerve over the internal carotid artery into the opticocarotid triangle, which is a difficult region to safely access with a purely endoscopic endonasal approach. We present a case of an endoscopic-assisted microsurgical resection of a tuberculum sellae meningioma using a modified one-piece extended transbasal approach in a patient with unilateral visual loss. The approach allows both interhemispheric and subfrontal routes to the suprasellar region. Early optic nerve decompression and division of the falciform ligament is critical to optimize visual outcomes. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, optic nerve decompression, tumor-arachnoid dissection, and safe handling of the neurovascular structures. A gross total resection was achieved and the patient had restoration of normal vision with normal pituitary function. In summary, the modified one-piece extended transbasal approach with endoscopic assistance is an important strategy in the armamentarium for surgical management of tuberculum sellae meningiomas. The link to the video can be found at: https://www.youtube.com/watch?v=jKNtRzMSFVE .
蝶骨嵴脑膜瘤手术切除的最佳方法仍存在争议。手术入路的选择很大程度上基于多种因素，如肿瘤大小、范围以及相对于视神经管和颈内动脉的位置、血管包裹情况，还有术者的偏好。在这份手术视频文稿中，作者展示了一种开放经颅入路的重要性，当肿瘤向外侧延伸至视神经上方、越过颈内动脉进入视神经 - 颈动脉三角区时，单纯经鼻内镜入路很难安全抵达该困难区域。我们报告一例采用改良一体式扩大经鼻基底入路进行蝶骨嵴脑膜瘤内镜辅助显微手术切除的病例，该患者有单侧视力丧失。这种入路允许通过半球间和额下路径到达鞍上区域。早期视神经减压和镰状韧带离断对于优化视觉效果至关重要。本视频图谱展示了颅底入路、视神经减压、肿瘤 - 蛛网膜分离以及神经血管结构安全处理的手术技术和手术细节。实现了肿瘤全切，患者视力恢复正常，垂体功能正常。总之，改良一体式扩大经鼻基底入路在内镜辅助下是蝶骨嵴脑膜瘤手术治疗手段中的一项重要策略。视频链接可在：https://www.youtube.com/watch?v=jKNtRzMSFVE 找到。
