Section of Skull Base Surgery, Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
J Neurosurg Sci. 2021 Apr;65(2):103-117. doi: 10.23736/S0390-5616.20.05086-9. Epub 2020 Nov 27.
Endoscopic endonasal approaches (EEA) to the skull base have significantly impacted the management of lesions located in the cranial base. Specifically, lesions arising from the anterior cranial fossa, such as pituitary macroadenomas, craniopharyngiomas meningiomas and craniofacial malignancies have benefited from the development of such approaches. Understanding of the anatomy of the anterior fossa is of utmost importance for the successful selection of the approach and application of surgical techniques in EEA. In the current manuscript, we review the most relevant points of surgical anatomy and nuances of the surgical technique of EEA to the anterior fossa. Anatomical landmarks for the transtuberculum transplanum and transcribriform approaches are discussed and a step-by-step description for those approaches is presented. We reinforce that safe and effective application of such techniques follow the same principles of other skull base surgery techniques: mastering of surgical anatomy, adequate case selection, correct instrumentation and surgical experience.
经鼻内镜颅底手术（EEA）显著影响了颅底病变的治疗。具体来说，起源于前颅窝的病变，如垂体大腺瘤、颅咽管瘤、脑膜瘤和颅面恶性肿瘤，受益于这种手术方法的发展。理解前颅窝的解剖结构对于成功选择手术入路和应用 EEA 中的手术技术至关重要。在本手稿中，我们回顾了 EEA 到前颅窝的最相关的手术解剖要点和手术技术细节。讨论了经蝶骨结节和筛板入路的解剖标志，并对这些入路进行了逐步描述。我们强调，安全有效地应用这些技术遵循与其他颅底手术技术相同的原则：掌握手术解剖、适当的病例选择、正确的器械和手术经验。
