Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples, Italy.
Department of Advanced Biomedical Science, University of Napoli "Federico II", Naples, Italy.
Adv Tech Stand Neurosurg. 2024;53:65-78. doi: 10.1007/978-3-031-67077-0_5.
Tuberculum and planum meningiomas are challenging tumors per their critical location and neurovascular relationships. The standard treatment is usually represented by complete tumor removal, being the transcranial approaches the well-established routes. During the last decades, novel surgical routes have been experimented with emphasis on the concept of minimal invasive approaches. The peculiar perspective from below the endoscopic endonasal approach provides a short and direct access avoiding brain and neurovascular structures manipulation, featuring excellent outcomes and a reduced morbidity. Ideal indications are small or medium size midline meningiomas, with wide tuberculum sellae angle and deep sella at the sphenoid sinus, possibly with no optic nerve and/or vessels encasement. Adequate removal of paranasal structures and extended bony opening over the dural attachment provide a wide surgical corridor ensuring safe intradural exposure at the suprasellar area. The main advantage is related to early decompression of the optic apparatus and reduced manipulation of subchiasmatic perforating vessels, with improved visual outcomes. Direct exposure of the inferomedial aspect of the optic canals allows for maximal decompression in cases of tumor extending within. Transcranial approaches tend to be selected for larger tumors with lateral extension beyond optic nerves and supraclinoid carotid arteries, in inaccessible areas from an endonasal corridor.
颅底和鞍结节脑膜瘤因其关键位置和神经血管关系而极具挑战性。标准治疗方法通常是完全切除肿瘤，颅外入路是成熟的治疗途径。在过去几十年中，新的手术途径已经在尝试，重点是微创途径的概念。经鼻内镜下手术具有独特的从下方视角，提供了短而直接的入路，避免了对脑组织和神经血管结构的操作，具有出色的结果和降低的发病率。理想的适应证是中小型中线脑膜瘤，鞍结节角度宽，蝶窦内的鞍底深，视神经和/或血管无包绕。充分切除鼻旁窦结构和广泛的骨性开放，使硬膜附着处有宽阔的手术通道，可确保在鞍上区域安全进行硬脑膜内显露。主要优点与视神经装置的早期减压和减少对下丘脑穿通血管的操作有关，从而改善视力结果。视神经管的中下内侧面的直接显露可使肿瘤向内侧延伸的情况下获得最大程度的减压。对于从经鼻入路无法触及的外侧延伸至视神经和颈内动脉床突上段的大型肿瘤，倾向于选择颅外入路。
