小児脳腫瘍に対する経鼻内視鏡手術

Endoscopic Transnasal Surgery for Pediatric Brain Tumors

Point

・小児では蝶形骨洞や斜台が未発達なことがあり，年齢に応じた術野確保と蝶形後頭軟骨結合などの成長板への配慮が望ましい．

・成人同様に腹側頭蓋底への直線的術野を確保できるが，解剖学的制約や安静困難，啼泣時の頭蓋内圧上昇など特有のリスクがある．

・低侵襲下に病変切除・生検が可能なために多彩な疾患に応用でき，標的治療を前提とした分子診断においても臨床的価値をもつ．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年12月まで）。

　Pediatric brain tumors differ from their adult counterparts in terms of tumor biology, anatomical constraints, and surgical challenges. Endoscopic transnasal skull base surgery (ETS) has been widely adopted in adults, and is also increasingly being applied in children as a minimally invasive approach to sellar and parasellar lesions. In pediatric cases, ETS provides a direct ventral corridor; however, it is associated with unique limitations. These include underdeveloped paranasal sinuses restricting surgical space, adherence to postoperative rest is difficult, and the skull base or midfacial growth plates, particularly the sphenooccipital synchondrosis, may be affected. Furthermore, agitation and crying may cause abrupt intracranial pressure elevation, thereby jeopardizing skull base reconstruction. Despite these challenges, advances in endoscopic equipment, navigation, and multilayer reconstruction have enabled outcomes comparable to those in adults. Pediatric ETS is applied to a wide spectrum of tumors, including craniopharyngiomas, pituitary neuroendocrine tumors, chordomas, Rathke's cleft cysts, germ cell tumors, and optic pathway gliomas. In the era of targeted therapy, minimally invasive biopsy for molecular diagnosis has gained new clinical value for ETS. Perioperative management must address pediatric-specific risks, such as limited blood volume, higher cerebrospinal fluid leak rates, and long-term craniofacial development. Ultimately, pediatric ETS requires a multidisciplinary approach involving neurosurgeons, endocrinologists, otolaryngologists, anesthesiologists, oncologists, nurses, and other allied specialists, to achieve comprehensive care.