Neurological Surgery 脳神経外科48巻10号

2020年10月発行

解剖を中心とした脳神経手術手技

脳神経外科と耳鼻科合同による経鼻内視鏡頭蓋底手術

著者： 戸田正博¹ 植田良² 小澤宏之³

所属機関： ¹慶應義塾大学医学部脳神経外科 ²川崎市立川崎病院脳神経外科 ³慶應義塾大学医学部耳鼻咽喉科

ページ範囲：P.885 - P.893

Ⅰ．はじめに
　近年の内視鏡手術の発展に伴い，脳神経外科においても経鼻内視鏡手術が普及しつつある．さらに，さまざまな副鼻腔空間を経由して頭蓋底に到達する経鼻内視鏡頭蓋底手術（endoscopic endonasal skull base surgery：EESS）は，手術手技の効率化やエビデンスの蓄積とともに，頭蓋底疾患に対する治療選択肢として確立されつつある．
　EESSでは，脳神経外科医に馴染みのない領域の解剖知識や内視鏡手術特有の手技の習得が必要となる．本稿では，EESSを理解するための解剖・手術アプローチを中心に具体例を提示しつつ，さらにEESSに習熟した耳鼻科医とのチーム手術の実際と利点を交えながら概説する．

参考文献

1) Beer-Furlan A, Abi-Hachem R, Jamshidi AO, Carrau RL, Prevedello DM：Endoscopic trans-sphenoidal surgery for petroclival and clival meningiomas. J Neurosurg Sci 60：495-502, 2016

2) Cavallo LM, Messina A, Esposito F, de Divitiis O, Dal Fabbro M, de Divitiis E, Cappabianca P：Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 107：713-720, 2007

3) Chakravarthi S, Gonen L, Monroy-Sosa A, Khalili S, Kassam A：Endoscopic endonasal reconstructive methods to the anterior skull base. Semin Plast Surg 31：203-213, 2017

4) 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

5) Kassam AB, Prevedello DM, Thomas A, Gardner P, Mintz A, Snyderman C, Carrau R：Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern. Neurosurgery 62（3 Suppl 1）：57-72；discussion 72-74, 2008

6) Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P：Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63（1 Suppl 1）：ONS 44-52；discussion ONS52-53, 2008

7) Kim BY, Shin JH, Kang SG, Kim SW, Hong YK, Jeun SS, Kim SW, Cho JH, Park YJ：Bilateral modified nasoseptal “rescue” flaps in the endoscopic endonasal transsphenoidal approach. Laryngoscope 123：2605-2609, 2013

8) Kitano M, Taneda M：Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery. Neurosurgery 54：653-660；discussion 660-661, 2004

9) Kuga D, Toda M, Ozawa H, Ogawa K, Yoshida K：Endoscopic endonasal approach combined with a simultaneous transcranial approach for giant pituitary tumors. World Neurosurg 121：173-179, 2019

10) Laufer I, Anand VK, Schwartz TH：Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106：400-406, 2007

11) Lavigne P, Faden D, Gardner PA, Fernandez-Miranda JC, Wang EW, Snyderman CH：Validation of training levels in endoscopic endonasal surgery of the skull base. Laryngoscope 129：2253-2257, 2019

12) Martinez-Perez R, Silveira-Bertazzo G, Carrau RL, Prevedello DM：The importance of landmarks in endoscopic endonasal reinterventions：the transpterygoid transcavernous approach. Acta Neurochir（Wien）162：875-880, 2020

13) Ozawa H, Tomita T, Watanabe Y, Sekimizu M, Ito F, Ikari Y, Saito S, Toda M, Ogawa K：Sigmoid incision rescue nasoseptal flap technique for endoscopic endonasal skull base surgery. Acta Otolaryngol 136：636-640, 2016

14) Schwartz TH, Morgenstern PF, Anand VK：Lessons learned in the evolution of endoscopic skull base surgery. J Neurosurg 130：337-346, 2019

15) Shidoh S, Toda M, Kawase T, Nakajima H, Tomita T, Ogawa K, Yoshida K：Transoral vs. endoscopic endonasal approach for clival/upper cervical chordoma. Neurol Med Chir（Tokyo）54：991-998, 2014

16) Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB：What are the limits of endoscopic sinus surgery?：the expanded endonasal approach to the skull base. Keio J Med 58：152-160, 2009

17) Sylvester PT, Moran CJ, Derdeyn CP, Cross DT, Dacey RG, Zipfel GJ, Kim AH, Uppaluri R, Haughey BH, Tempelhoff R, Rich KM, Schneider J, Chole RA, Chicoine MR：Endovascular management of internal carotid artery injuries secondary to endonasal surgery：case series and review of the literature. J Neurosurg 125：1256-1276, 2016

18) Taniguchi M, Akutsu N, Mizukawa K, Kohta M, Kimura H, Kohmura E：Endoscopic endonasal translacerum approach to the inferior petrous apex. J Neurosurg 124：1032-1038, 2016

19) Wang J, Bidari S, Inoue K, Yang H, Rhoton A Jr：Extensions of the sphenoid sinus：a new classification. Neurosurgery 66：797-816, 2010