開頭・経鼻内視鏡同時併用手術の工夫

Innovations in Combined Surgery of Endoscopic Transsphenoidal Surgery and Craniotomy

Point

・開頭・経鼻内視鏡同時併用手術では，互いの死角となる部分を補いつつ，さらに両術者が相互の術野を共有することができ，安全に腫瘍の摘出を進めることができる．

・開頭・経鼻内視鏡同時併用手術では使用する器材が多いが，手術室内の器材の配置を工夫することで，手術に関わるスタッフがストレスなく自身の役割を遂行できる．

・修復医用材料を用いて，多層性に再建することで，自家組織を使用する必要がなく，低侵襲で，手術時間の短縮，術後ストレスの軽減，在院日数の短縮が得られる．

　Combined endoscopic transsphenoidal surgery and craniotomy may be useful for tumors extending into the suprasellar region or ventricles and for tumors extending simultaneously into the nasal sinuses and intracranial space. This method allows two surgeons to share the surgical field while compensating for each other's blind spots and allows for safe tumor removal by separating the normal structure from the tumor and protecting the normal structure. Simultaneous combined endoscopic transsphenoidal surgery and craniotomy require a lot of equipment; however, by devising the layout of the equipment in the operating room, the staff involved in the surgery can perform their roles more effectively. However, this method results in extensive dural and cranial defects, and prevention of cerebrospinal fluid leakage and perioperative surgical site infection is essential. Skull base reconstruction using autologous tissues and medical materials at appropriate locations can reduce the risk of postoperative cerebrospinal fluid leakage and surgical site infection. Furthermore, multilayered reconstruction using restorative medical materials eliminates the need for autologous tissue, is minimally invasive, shortens the operative time, reduces postoperative stress, and shortens the length of hospital stay. A combination of endoscopic transsphenoidal surgery and craniotomy will contribute to the improvement of the safety of highly difficult tumorectomies under a reliable skull base reconstruction method.