Todeschini Alexandre B, Otto Bradley A, Carrau Ricardo L, Prevedello Daniel M
Department of Neurological Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Otolaryngology, Head and Neck Surgery, Wexner Medical Center, The Ohio State University College of Medicine, Columbus, OH, USA.
J Neurosurg Sci. 2018 Dec;62(6):617-626. doi: 10.23736/S0390-5616.18.04492-2. Epub 2018 May 28.
Meningiomas are the most common primary intracranial tumor, arising from different locations, including the skull base. Despite advances in adjuvant treatments, surgical resection remains the main and best treatment for meningiomas. New surgical strategies, such as the endoscopic endonasal approach, have greatly contributed in achieving maximum and total safe resection, preserving the patient's neurological function.
Based on the senior authors large experience and a review of the current literature, we have compiled this paper.
We review the surgical technique used at our institution and the most relevant aspects of patient selection when considering resecting a skull base meningioma using the the EEA. Further consideration is given to some skull base meningiomas arising from specific locations with some case examples.
The EEA is not an ideal approach for every skull base meningioma. Careful evaluation of the neurovascular structures surrounding the tumor is imperative to select the appropriate surgical corridor for a safe resection. Nevertheless, for appropriately selected cases, the endoscopic technique is a very valuable tool with some evidences of being superior to the microscopic transcranial approach. A dual-trained surgeon, in both endoscopic and transcranial approaches, is the best alternative to achieve the best patient outcome.
脑膜瘤是最常见的原发性颅内肿瘤，起源于不同部位，包括颅底。尽管辅助治疗取得了进展，但手术切除仍然是脑膜瘤的主要且最佳治疗方法。新的手术策略，如内镜鼻内入路，在实现最大程度的安全全切并保留患者神经功能方面发挥了巨大作用。
基于资深作者的丰富经验以及对当前文献的回顾，我们撰写了本文。
我们回顾了本机构所采用的手术技术，以及在考虑使用内镜鼻内入路切除颅底脑膜瘤时患者选择的最相关方面。还结合一些病例实例，对特定部位起源的一些颅底脑膜瘤进行了进一步探讨。
内镜鼻内入路并非适用于所有颅底脑膜瘤。必须仔细评估肿瘤周围的神经血管结构，以选择合适的手术通道进行安全切除。然而，对于经过适当选择的病例，内镜技术是一种非常有价值的工具，且有证据表明其优于显微镜下经颅入路。一名同时具备内镜和经颅手术技能的双资质外科医生，是实现最佳患者预后的最佳选择。
