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首页> 外文期刊>Journal of neurosurgery. >Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum.
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Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum.

机译：扩大鼻内入路，一种完全内窥镜经鼻入路切除中线上睑上颅咽咽喉瘤：一种基于漏斗的新分类。

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OBJECT: Craniopharyngiomas are notoriously difficult to treat. Surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. Because of their parasellar location, often extending well beyond the sella, these tumors challenge vision and pituitary and hypothalamic function. New techniques are needed to improve outcomes in patients with these tumors while decreasing treatment morbidity. An endoscopic expanded endonasal approach (EEA) is one such technique that warrants understanding and evaluation. The authors explain the techniques and approach used for the endoscopic endonasal resection of suprasellar craniopharyngiomas and introduce a tumor classification scheme. METHODS: The techniques and approach used for the endoscopic, endonasal resection of suprasellar craniopharyngiomas is explained, including the introduction of a tumor classification scheme. This scheme is helpful for understanding both the appropriate expanded approach as well as relevant involved anatomy. RESULTS: The classification scheme divides tumors according to their suprasellar extension: Type I is preinfundibular; Type II is transinfundibular (extending into the stalk); Type III is retroinfundibular, extending behind the gland and stalk, and has 2 subdivisions (IIIa, extending into the third ventricle; and IIIb, extending into the interpeduncular cistern); and Type IV is isolated to the third ventricle and/or optic recess and is not accessible via an endonasal approach. CONCLUSIONS: The endoscopic EEA requires a thorough understanding of both sinus and skull base anatomy. Moreover, in its application for craniopharyngiomas, an understanding of tumor growth and extension with respect to the optic chiasm and infundibulum is critical to safely approach the lesion via an endonasal route.
机译：目的：颅咽管瘤众所周知很难治疗。外科医生必须权衡积极切除的风险与长期复发的挑战。由于它们位于通常位于蝶鞍之外的肩旁位置，这些肿瘤挑战了视力以及垂体和下丘脑功能。需要新的技术来改善这些肿瘤患者的预后，同时降低治疗的发病率。内窥镜鼻腔扩大术（EEA）就是其中一种技术，需要了解和评估。作者解释了用于上睑上颅咽咽喉癌的内镜鼻腔内切除术的技术和方法，并介绍了一种肿瘤分类方案。方法：解释了用于上睑上颅咽咽喉癌的内镜，鼻内切除术的技术和方法，包括引入肿瘤分类方案。该方案有助于理解适当的扩展方法以及相关的相关解剖结构。结果：分类方案根据肿瘤上突扩展来划分肿瘤。 II型是跨鼻窦（延伸到茎中）; III型是在前腺后部，延伸到腺体和茎的后面，并有两个细分（IIIa，延伸到第三脑室; IIIb，延伸到椎弓根间的水箱）。 IV型隔离在第三脑室和/或视神经凹处，不能通过鼻内入路进入。结论：内窥镜EEA需要对鼻窦和颅底的解剖结构有透彻的了解。此外，在其用于颅咽管瘤的应用中，了解关于视交叉和漏斗的肿瘤生长和扩展对于通过鼻内途径安全地接近病变至关重要。

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