小児鞍上部腫瘍—開頭法

Suprasellar Tumor-Craniotomy

Point

・小児鞍上部腫瘍に対する開頭法は，広い術野が得られる．

・脳の圧排を軽減するため，髄液の排出が重要である．

・腫瘍の部位や進展方向でアプローチが選択される．

　Surgical procedures for pediatric suprasellar tumors include craniotomy and nasal surgery. Craniotomies are increasingly performed with a microscope, exoscope, and endoscope, while nasal surgery is performed mainly with endoscopes. In some cases, craniotomy and nasal surgery are performed together. This article describes craniotomy. Due to its large surgical field, craniotomy is often chosen for large tumors in the suprasellar region, tumors located above the optic chiasm and optic nerve, tumors extending laterally, and hypervascularized tumors. It is the surgical technique of choice for many neurosurgeons because they are familiar with it.

　Craniotomies include bilateral frontal and frontotemporal craniotomies. The interhemispheric and subfrontal approaches involve bilateral frontal craniotomy, pterional approach, orbitozygomatic approach, subtemporal approach using temporal-occipital craniotomy, and transpetrosal transtentorial approach using temporal-occipital-suboccipital craniotomy. The approach was selected based on the direction of tumor extension and relationship between the tumor and optic nerve, optic chiasm, and blood vessels. This paper describes the frequently used interhemispheric and pterional approaches based on our experience.