Akutsu Hiroyoshi, Hongo Takeshi
Department of Neurosurgery, Dokkyo Medical University.
No Shinkei Geka. 2024 Mar;52(2):347-357. doi: 10.11477/mf.1436204919.
Preoperative simulation for endoscopic endonasal approach(EEA)using computed tomography and magnetic resonance imaging evaluates tumor extension and the relationship between adjacent structure(the pituitary stalk, major vessels, and cranial nerves); therefore, preoperative planning of nasal procedure, skull base bony removal, and cranial base reconstruction are possible. Additionally, three-dimensional(3D)fusion image aids surgeons to visualize intraoperative 3D findings. These preoperative simulations are critical to avoid complications and predict pitfalls perioperatively. However, tumor consistency or adhesion with adjacent structure cannot be predicted but is judged perioperatively, which affects the extent of tumor resection. This manuscript describes important points of preoperative simulation for EEA, especially the transplanum-transtuberculum approach for craniopharyngiomas or tuberculum sellae meningiomas, showing some examples in patients.
使用计算机断层扫描和磁共振成像进行鼻内镜鼻内入路（EEA）术前模拟，可评估肿瘤的扩展情况以及与相邻结构（垂体柄、主要血管和颅神经）的关系；因此，鼻手术、颅底骨质切除和颅底重建的术前规划成为可能。此外，三维（3D）融合图像有助于外科医生可视化术中的3D发现。这些术前模拟对于避免并发症和预测围手术期的陷阱至关重要。然而，肿瘤的质地或与相邻结构的粘连无法预测，只能在围手术期进行判断，这会影响肿瘤切除的范围。本文描述了EEA术前模拟的要点，特别是针对颅咽管瘤或鞍结节脑膜瘤的经筛板-经结节入路，并展示了一些患者实例。
