頭蓋底脊索腫の外科治療—神経内視鏡手術を中心に

Surgical Strategy for Skull Base Chordoma:Recent Advent of Neuroendoscopic Surgery

Point

・脊索腫は，斜台を中心とした頭蓋底に発生する極めて稀な悪性腫瘍である．

・肉眼的に摘出するのみでは高率に再発するため，浸潤した辺縁骨組織を含めた切除が必要である．

・近年，神経内視鏡技術の進歩により，鼻腔を利用しての切除が可能となり，侵襲性の低減と手術単独での治癒率が向上している．

　Skull base chordoma is a rare bone tumor that is predominantly found in the clival area and considered to originate from the notochordal remnants. Chordoma is characterized by an aggressive nature and has a high risk of repeated recurrence despite multimodal treatments, including extensive surgical resection and high-dose radiotherapy. Thus, extensive surgical resection of the tumor and adjacent bony structures is strongly recommended. However, surgery was difficult because of the deep location of the lesion and involvement of important anatomies such as the cranial nerves and internal carotid arteries. Recent advent of endoscopic technology has changed visibility of the surgical field and accessibility, and surgical outcomes of this intractable tumor have dramatically changed. In this article, we present our surgical strategy of skull base chordoma aiming for radical surgical resection, focusing on the neuroendoscopic skull base surgery.