頭蓋咽頭腫や鞍結節部髄膜腫に対する経鼻内視鏡手術

Preoperative Simulation of Endoscopic Endonasal Approach for Craniopharyngiomas or Tuberculum Sellae Meningiomas

Point

・術前CT，MRI，3次元融合画像を用いて，腫瘍の進展や周囲構造（下垂体茎・主幹動脈・脳神経）との位置関係は評価・視覚化できるため，鼻・副鼻腔操作，頭蓋底骨削除，頭蓋底再建の手技の選択は想定できる．

・腫瘍の硬さ・癒着の程度，上下垂体動脈をはじめとした穿通枝の走行は術前画像では判断できないため，術中の状況に応じて判断するしかなく，腫瘍の摘出度もそれによって左右される．

＊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4月まで）。

　Preoperative simulation for endoscopic endonasal approach（EEA）using computed tomography and magnetic resonance imaging evaluates tumor extension and the relationship between adjacent structure（the pituitary stalk, major vessels, and cranial nerves）; therefore, preoperative planning of nasal procedure, skull base bony removal, and cranial base reconstruction are possible. Additionally, three-dimensional（3D）fusion image aids surgeons to visualize intraoperative 3D findings. These preoperative simulations are critical to avoid complications and predict pitfalls perioperatively. However, tumor consistency or adhesion with adjacent structure cannot be predicted but is judged perioperatively, which affects the extent of tumor resection. This manuscript describes important points of preoperative simulation for EEA, especially the transplanum-transtuberculum approach for craniopharyngiomas or tuberculum sellae meningiomas, showing some examples in patients.