傍鞍部髄膜腫

The Transcranial Approach for Parasellar Meningiomas

Point

・傍鞍部髄膜腫は，視機能低下を主訴に指摘されることが多い．無症候性の症例に対する予防的切除の適応は，症例ごとに慎重な検討が必要である．

・硬膜内操作を開始する前に皮弁，側頭筋などの軟部組織の移動，頭蓋底骨削を行い，腫瘍への栄養動脈遮断と腫瘍摘出スペースを生み出す．

・脳ベラをうまく用いてスペースを生み出し，両手操作が行えると，細血管剝離や深部での止血操作が安全に遂行しやすくなる．

＊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：2027年8月まで）。

　Patients with parasellar meningiomas often initially present with visual impairment. Understanding the surrounding anatomy is essential when preparing for surgery of parasellar meningiomas, as this region includes various crucial neurovascular structures. Historically, invasive craniotomy, such as the orthozygomatic approach or zygotomy, has often been attempted to access the region; however, the use of these invasive approaches has become less common, because of the accumulation of anatomical knowledge, as well as the development of surgical techniques and devices, including the endonasal endoscopic approach. Herein, we summarize how we perform surgery for parasellar meningiomas, and outline tips and pitfalls that could be useful for young residents and trainees who are new to the skull base field.