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内镜经鼻颅底硬膜外后方岩斜切除术:进入鞍后和上斜坡区的关键操作。

Endoscopic endonasal extradural posterior clinoidectomy: A key maneuver to access the retrosellar and upper retroclival area.

机构信息

Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland.

Department of Neurosurgery, Neuromed, Pozzilli, Italy.

出版信息

J Clin Neurosci. 2024 Nov;129:110866. doi: 10.1016/j.jocn.2024.110866. Epub 2024 Oct 17.

DOI:10.1016/j.jocn.2024.110866
PMID:39423488
Abstract

BACKGROUND

Endoscopic endonasal posterior clinoidectomy represents an important maneuver to improve access and visualization of the retrosellar and upper clivus area [1]. Three different techniques have been described in order to access and remove the posterior clinoid: 1) the intradural pituitary transposition [2], the interdural pituitary transposition [3] and a completely extradural technique [4].

CASE DESCRIPTION

We present here a case of retrosellar and retroclival chordoma that has been removed through endoscopic endonasal approach. Technical nuances of the endonasal extradural posterior clinoidectomy are presented.

CONCLUSION

Endoscopic endonasal extradural posterior clinoidectomy allows to access this complex anatomical region with the advantage of avoiding major bleeding from the cavernous sinus and endocrinological impairment.

摘要

背景

经鼻内镜颅底后床突切除术是改善鞍后和颅颈交界区显露的重要手段[1]。为了进入和切除颅底后床突,已经描述了三种不同的技术:1)经硬膜内垂体移位[2]、经硬膜外垂体移位[3]和完全经硬膜外技术[4]。

病例描述

我们在此介绍一例通过经鼻内镜入路切除鞍后和斜坡脊索瘤的病例。本文介绍了经鼻内镜硬膜外颅底后床突切除术的技术要点。

结论

经鼻内镜硬膜外颅底后床突切除术可以进入这个复杂的解剖区域,避免了海绵窦大出血和内分泌功能障碍的风险。

相似文献

1
Endoscopic endonasal extradural posterior clinoidectomy: A key maneuver to access the retrosellar and upper retroclival area.内镜经鼻颅底硬膜外后方岩斜切除术:进入鞍后和上斜坡区的关键操作。
J Clin Neurosci. 2024 Nov;129:110866. doi: 10.1016/j.jocn.2024.110866. Epub 2024 Oct 17.
2
Frontolateral Approach Combined with Endoscopic Endonasal Extradural Posterior Clinoidectomy to the Upper Clival Region: Anatomic and Feasibility Study.额外侧入路联合鼻内镜下经鼻硬脑膜外后床突切除术治疗上斜坡区:解剖学与可行性研究
World Neurosurg. 2018 Mar;111:86-93. doi: 10.1016/j.wneu.2017.12.047. Epub 2017 Dec 19.
3
Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition.经鼻内镜颅底锁孔蝶鞍后床突切除术伴硬脑膜内垂体移位。
J Neurosurg. 2014 Jul;121(1):91-9. doi: 10.3171/2014.3.JNS131865. Epub 2014 May 9.
4
Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery.内镜下经鼻手术中的扩大经海绵窦后床突切除术
J Neurosurg. 2024 Oct 11;142(3):777-787. doi: 10.3171/2024.6.JNS24606. Print 2025 Mar 1.
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Endoscopic Resection of Clival Malignancies.斜坡恶性肿瘤的内镜下切除术
Otolaryngol Clin North Am. 2017 Apr;50(2):315-329. doi: 10.1016/j.otc.2016.12.008.
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Endoscopic Endonasal Transclival Resection of the Upper Clival Meningioma.经鼻内镜经斜坡入路切除斜坡上部脑膜瘤
Turk Neurosurg. 2018;28(3):505-509. doi: 10.5137/1019-5149.JTN.17010-16.4.
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Endoscopic endonasal posterior clinoidectomy.鼻内镜下经鼻后床突切除术
Surg Neurol Int. 2012;3:64. doi: 10.4103/2152-7806.97008. Epub 2012 Jun 9.
8
[Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 1. Topographic and anatomical features of the clivus and adjacent structures].[经鼻内镜扩大后入路(经斜坡)治疗斜坡区及颅后窝腹侧肿瘤。第1部分。斜坡及相邻结构的局部解剖学特征]
Zh Vopr Neirokhir Im N N Burdenko. 2017;81(4):5-16. doi: 10.17116/neiro20178145-16.
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Operative nuances and surgical limits of the endoscopic approach to clival chordomas and chondrosarcomas: A single-center experience of 72 patients.内镜入路治疗颅底脊索瘤和软骨肉瘤的手术细节和手术限制:单中心 72 例患者的经验。
Clin Neurol Neurosurg. 2021 Sep;208:106875. doi: 10.1016/j.clineuro.2021.106875. Epub 2021 Aug 5.
10
Clival chordomas: considerations after 16 years of endoscopic endonasal surgery.斜坡脊索瘤:内镜经鼻颅底手术 16 年后的相关考虑。
J Neurosurg. 2018 Feb;128(2):329-338. doi: 10.3171/2016.11.JNS162082. Epub 2017 Apr 14.

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