Neurological Surgery 脳神経外科38巻6号

2010年06月発行

総説

内視鏡頭蓋底手術

著者： 戸田正博¹

所属機関： ¹慶應義塾大学医学部脳神経外科

ページ範囲：P.505 - P.514

Ⅰ．はじめに

　下垂体腫瘍を中心としたトルコ鞍内病変に対する手術法は，開頭手術から経蝶形骨手術へと移行し，現在の標準的手術として確立されたが，近年の内視鏡手術の発展や新たな手術機器の開発に伴い，内視鏡下の経蝶形骨手術が普及しつつある¹⁰⁾．さらに内視鏡の導入により，顕微鏡下では到達困難な部位まで操作可能であることが明らかになり，その対象が下垂体腫瘍から頭蓋底疾患へと拡大している^{11,15,20,34,35)}．今後は低侵襲性のみならず根治性を目指して，頭蓋底疾患においても開頭手術から経鼻手術へ移行する症例が増えるかもしれない．

　一方，内視鏡頭蓋底手術では，これまでとは異なる外科解剖知識の習得や内視鏡下の新たな手術手技の習得が必要である．また，経鼻内視鏡手術の限界も明らかにされつつあり，適応疾患を慎重に選択することが重要である．本稿では，基本的に経鼻アプローチによる内視鏡単独の頭蓋底手術を内視鏡頭蓋底手術と呼び，これまでの歴史的背景，現状を概説し，今後の展望についても考察する．

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