Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA.
Department of Neurological Surgery, University of Joinville Region, and Neurological and Neurosurgical Clinic of Joinville, Joinville, SC, Brazil.
Acta Neurochir (Wien). 2020 Oct;162(10):2403-2408. doi: 10.1007/s00701-020-04368-9. Epub 2020 May 9.
Expanded endonasal approaches can provide direct access to the midline skull base from the anterior cranial fossa to the ventral foramen magnum. Surgical strategies of bone drilling, dural opening, and intradural dissection can determine the area of surgical exposure and instrument handling, affecting the safety of devascularizing/debulking suprasellar tumors.
We describe an expanded endoscopic endonasal approach for suprasellar lesions, with stepwise image-guided dissections highlighting surgical pearls and pitfalls to enhance surgical safety. This article presents transnasal intra-third-ventricular anatomy from trans-tuber cinereum, and trans-lamina terminalis approaches, comparing subchiasmatic and suprachiasmatic trajectories.
The rostral extension via endoscopic endonasal transsellar-transtubercular-transplanum approaches can provide a safe and feasible route for suprasellar lesions, in subchiasmatic, suprachiasmatic, and intraventricular regions.
扩大经鼻内镜入路可从前颅窝到腹侧枕骨大孔提供直达中线颅底的通道。骨钻、硬脑膜切开和硬脑膜内解剖的手术策略可以确定手术暴露和器械操作的范围，影响去血管/去瘤缩小颅咽管瘤的安全性。
我们描述了一种用于鞍上病变的扩大内镜经鼻内镜入路，逐步进行图像引导下的解剖，突出手术要点和陷阱，以提高手术安全性。本文介绍了经灰结节经鼻内第三脑室解剖和经终板入路，比较了视交叉下和视交叉上的轨迹。
通过经蝶鞍-经灰结节-经蝶鞍-经颅底入路的内镜经鼻延伸可以为视交叉下、视交叉上和脑室区域的鞍上病变提供安全可行的途径。
