Neurological Surgery 脳神経外科47巻5号

2019年05月発行

総説

経鼻内視鏡手術の現状と未来

著者： 吉本幸司¹ 藤尾信吾¹

所属機関： ¹鹿児島大学大学院医歯学総合研究科脳神経外科

ページ範囲：P.503 - P.509

Ⅰ．はじめに
　経蝶形骨洞手術は，1907年にHermann Schlofferが世界で最初に下垂体腫瘍摘出術の成功例を報告し，1910年にHarvey Cushingと耳鼻科医のOskar Hirschがほとんど同時期に，現在とほぼ同じアプローチ法で初めて手術を行ったとされ，現在ちょうど100年を超えたところである．
　感染症などの合併症の頻度が高く，次第に廃れていった経蝶形骨洞手術が注目を浴びたのは，1960年代後半にJules Hardyが顕微鏡下の経蝶形骨洞的下垂体腫瘍摘出術を報告してからである²⁴⁾．以後“Hardy法”として普及しているが，その後1990年代になって耳鼻科領域で行われた内視鏡を用いた経蝶形骨洞手術の報告以降，その有用性から現在では経鼻的な内視鏡下経蝶形骨洞的下垂体腫瘍摘出術が急速に普及している^13,22,49)．
　Hardy法による手術法の改良を第2の技術革新とするならば，近年の内視鏡を用いた経鼻手術の普及は第3の技術革新と言える．内視鏡を用いることにより術野の観察性が向上し，トルコ近傍のみならず，第三脳室内や前頭蓋底，斜台部病変に対する経鼻内視鏡頭蓋底手術も急速に発展してきている．このような状況を踏まえ，本稿では経鼻内視鏡手術の現状と将来の展望について解説する．

参考文献

1) Ammirati M, Wei L, Ciric I：Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery：a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 84：843-849, 2013

2) Barkhoudarian G, Del Carmen Becerra Romero A, Laws ER：Evaluation of the 3-dimensional endoscope in transsphenoidal surgery. Neurosurgery 73（1 Suppl Operative）：ons74-78；discussion ons78-79, 2013

3) Cappabianca P, Cavallo LM, de Divitiis O, de Angelis M, Chiaramonte C, Solari D：Endoscopic endonasal extended approaches for the management of large pituitary adenomas. Neurosurg Clin N Am 26：323-331, 2015

4) Cavallo LM, Solari D, Esposito F, Cappabianca P：The endoscopic endonasal approach for the management of craniopharyngiomas involving the third ventricle. Neurosurg Rev 36：27-37；discussion 38, 2013

5) Chibbaro S, Cornelius JF, Froelich S, Tigan L, Kehrli P, Debry C, Romano A, Herman P, George B, Bresson D：Endoscopic endonasal approach in the management of skull base chordomas--clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev 37：217-224；discussion 224-225, 2014

6) Clark AJ, Jahangiri A, Garcia RM, George JR, Sughrue ME, McDermott MW, El-Sayed IH, Aghi MK：Endoscopic surgery for tuberculum sellae meningiomas：a systematic review and meta-analysis. Neurosurg Rev 36：349-359, 2013

7) Conger A, Zhao F, Wang X, Eisenberg A, Griffiths C, Esposito F, Carrau RL, Barkhoudarian G, Kelly DF：Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery：trends in repair failure and meningitis rates in 509 patients. J Neurosurg 130：861-875, 2018

8) Conger AR, Lucas J, Zada G, Schwartz TH, Cohen-Gadol AA：Endoscopic extended transsphenoidal resection of craniopharyngiomas：nuances of neurosurgical technique. Neurosurg Focus 37：E10, 2014

9) Dallapiazza R, Bond AE, Grober Y, Louis RG, Payne SC, Oldfield EH, Jane JA Jr：Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0-2 nonfunctioning pituitary macroadenomas at a single institution. J Neurosurg 121：511-517, 2014

10) de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A：Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 61（5 Suppl 2）：219-227；discussion 228, 2007

11) de Divitiis E, Cavallo LM, Esposito F, Stella L, Messina A：Extended endoscopic transsphenoidal approach for tuberculum sellae meningiomas. Neurosurgery 61（5 Suppl 2）：229-237；discussion 237-238, 2007

12) de Paiva Neto MA, Vandergrift A, Fatemi N, Gorgulho AA, Desalles AA, Cohan P, Wang C, Swerdloff R, Kelly DF：Endonasal transsphenoidal surgery and multimodality treatment for giant pituitary adenomas. Clin Endocrinol（Oxf）72：512-519, 2010

13) Doglietto F, Prevedello DM, Jane JA Jr, Han J, Laws ER Jr：Brief history of endoscopic transsphenoidal surgery--from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurg Focus 19：E3, 2005

14) Elliott RE, Jane JA Jr, Wisoff JH：Surgical management of craniopharyngiomas in children：meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 69：630-643；discussion 643, 2011

15) Esposito F, Dusick JR, Fatemi N, Kelly DF：Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 60（4 Suppl 2）：295-303；discussion 303-304, 2007

16) Fathalla H, Cusimano MD, Di Ieva A, Lee J, Alsharif O, Goguen J, Zhang S, Smyth H：Endoscopic versus microscopic approach for surgical treatment of acromegaly. Neurosurg Rev 38：541-548；discussion 548-549, 2015

17) Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Mendenhall WM, Suárez C, Rinaldo A, Ferlito A：Clival chordomas：a pathological, surgical, and radiotherapeutic review. Head Neck 36：892-906, 2014

18) Gondim JA, Almeida JP, Albuquerque LA, Gomes EF, Schops M：Giant pituitary adenomas：surgical outcomes of 50 cases operated on by the endonasal endoscopic approach. World Neurosurg 82：e281-290, 2014

19) Gui S, Zong X, Wang X, Li C, Zhao P, Cao L, Zhang Y：Classification and surgical approaches for transnasal endoscopic skull base chordoma resection：a 6-year experience with 161 cases. Neurosurg Rev 39：321-332；discussion 332-333, 2016

20) Hardesty DA, Montaser AS, Beer-Furlan A, Carrau RL, Prevedello DM：Limits of endoscopic endonasal surgery for Ⅲ ventricle craniopharyngiomas. J Neurosurg Sci 62：310-321, 2018

21) Hoffman HJ：Surgical management of craniopharyngioma. Pediatr Neurosurg 21 Suppl 1：44-49, 1994

22) Jho HD, Carrau RL：Endoscopic endonasal transsphenoidal surgery：experience with 50 patients. J Neurosurg 87：44-51, 1997

23) Juraschka K, Khan OH, Godoy BL, Monsalves E, Kilian A, Krischek B, Ghare A, Vescan A, Gentili F, Zadeh G：Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas：institutional experience and predictors of extent of resection. J Neurosurg 121：75-83, 2014

24) Kanter AS, Dumont AS, Asthagiri AR, Oskouian RJ, Jane JA Jr, Laws ER Jr：The transsphenoidal approach. A historical perspective. Neurosurg Focus 18：e6, 2005

25) Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM：Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas：a new classification based on the infundibulum. J Neurosurg 108：715-728, 2008

26) Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH：The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas. World Neurosurg 76：318-327, 2011

27) Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH：Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 77：713-724, 2012

28) Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH：Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas. Pituitary 15：150-159, 2012

29) Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, Fernandez-Miranda JC, Snyderman CH：Endoscopic endonasal approach for resection of cranial base chordomas：outcomes and learning curve. Neurosurgery 71：614-624；discussion 624-625, 2012

30) Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Tyler-Kabara EC, Wang EW, Snyderman CH：Endoscopic endonasal surgery for craniopharyngiomas：surgical outcome in 64 patients. J Neurosurg 119：1194-1207, 2013

31) Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA：Endoscopic endonasal surgery for suprasellar meningiomas：experience with 75 patients. J Neurosurg 120：1326-1339, 2014

32) Koutourousiou M, Fernandez-Miranda JC, Wang EW, Snyderman CH, Gardner PA：The limits of transsellar/transtuberculum surgery for craniopharyngioma. J Neurosurg Sci 62：301-309, 2018

33) Li A, Liu W, Cao P, Zheng Y, Bu Z, Zhou T：Endoscopic versus microscopic transsphenoidal surgery in the treatment of pituitary adenoma：a systematic review and meta-analysis. World Neurosurg 101：236-246, 2017

34) Liu JK, Sevak IA, Carmel PW, Eloy JA：Microscopic versus endoscopic approaches for craniopharyngiomas：choosing the optimal surgical corridor for maximizing extent of resection and complication avoidance using a personalized, tailored approach. Neurosurg Focus 41：E5, 2016

35) Moussazadeh N, Prabhu V, Bander ED, Cusic RC, Tsiouris AJ, Anand VK, Schwartz TH：Endoscopic endonasal versus open transcranial resection of craniopharyngiomas：a case-matched single-institution analysis. Neurosurg Focus 41：E7, 2016

36) Muskens IS, Briceno V, Ouwehand TL, Castlen JP, Gormley WB, Aglio LS, Zamanipoor Najafabadi AH, van Furth WR, Smith TR, Mekary RA, Broekman MLD：The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis. Acta Neurochir（Wien）160：59-75, 2018

37) Nakao N, Itakura T：Surgical outcome of the endoscopic endonasal approach for non-functioning giant pituitary adenoma. J Clin Neurosci 18：71-75, 2011

38) Nishioka H, Hara T, Usui M, Fukuhara N, Yamada S：Simultaneous combined supra-infrasellar approach for giant/large multilobulated pituitary adenomas. World Neurosurg 77：533-539, 2012

39) Nishioka H, Fukuhara N, Yamaguchi-Okada M, Yamada S：Endoscopic endonasal surgery for purely intrathird ventricle craniopharyngioma. World Neurosurg 91：266-271, 2016

40) Phan K, Xu J, Reddy R, Kalakoti P, Nanda A, Fairhall J：Endoscopic endonasal versus microsurgical transsphenoidal approach for growth hormone-secreting pituitary adenomas-systematic review and meta-analysis. World Neurosurg 97：398-406, 2017

41) Rahme RJ, Arnaout OM, Sanusi OR, Kesavabhotla K, Chandler JP：Endoscopic approach to clival chordomas：the northwestern experience. World Neurosurg 110：e231-e238, 2018

42) Schroeder HW：Indications and limitations of the endoscopic endonasal approach for anterior cranial base meningiomas. World Neurosurg 82（6 Suppl）：S81-85, 2014

43) Shimony N, Gonen L, Shofty B, Abergel A, Fliss DM, Margalit N：Surgical resection of skull-base chordomas：experience in case selection for surgical approach according to anatomical compartments and review of the literature. Acta Neurochir（Wien）159：1835-1845, 2017

44) Singh H, Essayed WI, Cohen-Gadol A, Zada G, Schwartz TH：Resection of pituitary tumors：endoscopic versus microscopic. J Neurooncol 130：309-317, 2016

45) Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA Jr：Endoscopic vs microsurgical transsphenoidal surgery for acromegaly：outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab 98：3190-3198, 2013

46) Steno J, Malácek M, Bízik I：Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas：correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 54：1051-1058；discussion 1058-1060, 2004

47) Tang B, Xie SH, Xiao LM, Huang GL, Wang ZG, Yang L, Yang XY, Xu S, Chen YY, Ji YQ, Zeng EM, Hong T：A novel endoscopic classification for craniopharyngioma based on its origin. Sci Rep 8：10215, 2018

48) Turel MK, Tsermoulas G, Reddy D, Andrade-Barazarte H, Zadeh G, Gentili F：Endonasal endoscopic transsphenoidal excision of tuberculum sellae meningiomas：a systematic review. J Neurosurg Sci 60：463-475, 2016

49) Wang AJ, Zaidi HA, Laws ED Jr：History of endonasal skull base surgery. J Neurosurg Sci 60：441-453, 2016

50) Wang KC, Kim SK, Choe G, Chi JG, Cho BK：Growth patterns of craniopharyngioma in children：role of the diaphragm sellae and its surgical implication. Surg Neurol 57：25-33, 2002

51) Wannemuehler TJ, Rubel KE, Hendricks BK, Ting JY, Payner TD, Shah MV, Cohen-Gadol AA：Outcomes in transcranial microsurgery versus extended endoscopic endonasal approach for primary resection of adult craniopharyngiomas. Neurosurg Focus 41：E6, 2016

52) Yano S, Hide T, Shinojima N：Efficacy and complications of endoscopic skull base surgery for giant pituitary adenomas. World Neurosurg 99：533-542, 2017

53) Yoshimoto K, Mukae N, Kuga D, Inoue D, Hashizume M, Iihara K：Dual optical channel three-dimensional neuroendoscopy：clinical application as an assistive technique in endoscopic endonasal surgery. Interdiscip Neurosurg 6：45-50, 2016

54) Yu T, Sun X, Ren X, Cui X, Wang J, Lin S：Intraventricular craniopharyngiomas：surgical management and outcome analyses in 24 cases. World Neurosurg 82：1209-1215, 2014

55) Zaidi HA, Zehri A, Smith TR, Nakaji P, Laws ER Jr：Efficacy of three-dimensional endoscopy for ventral skull base pathology：a systematic review of the literature. World Neurosurg 86：419-431, 2016

56) Zaidi HA, Awad AW, Bohl MA, Chapple K, Knecht L, Jahnke H, White WL, Little AS：Comparison of outcomes between a less experienced surgeon using a fully endoscopic technique and a very experienced surgeon using a microscopic transsphenoidal technique for pituitary adenoma. J Neurosurg 124：596-604, 2016

57) Zoli M, Rossi N, Friso F, Sturiale C, Frank G, Pasquini E, Mazzatenta D：Limits of endoscopic endonasal approach for cranio-vertebral junction tumors. J Neurosurg Sci 62：356-368, 2018