頭蓋底正中部髄膜腫—経鼻内視鏡手術の視点から

Meningiomas in the Central Skull Base:From the Perspective of Endoscopic Transnasal Surgery

Point

・経鼻内視鏡手術は頭蓋底正中部髄膜腫に対する低侵襲かつ効果的な到達法である．

・頭蓋底正中部髄膜腫に対する経鼻内視鏡手術では，開頭手術に比して神経損傷のリスクを低減し得る．

・内視鏡手術に不慣れな術者ではリスクも伴うため，習熟度や到達限界を理解し手術法を選択する．

＊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）。

　Recent advancements in endoscopic transnasal surgery（ETS）have expanded the application of this technique to meningiomas in the central skull base area, offering a less invasive alternative with a potentially lower physical burden on patients than conventional microscopic skull base surgery. Notably, while ETS allows surgeons to reach tumors without traversing the brain and nerves, thus theoretically reducing the risk of cranial nerve damage, it requires a high level of proficiency to avoid inadequate resection and tumor recurrence. In this article, we discuss the various surgical considerations, including preoperative imaging, surgical setting, nasal cavity expansion, skull base opening, tumor removal, and skull base reconstruction, as general procedures for specific meningiomas. We further describe the concept and details of our multi-layer fascial closure technique for dural repair in ETS, underlining the importance of skilled dural reconstruction in preventing postoperative complications. In conclusion, while ETS for skull base meningiomas presents a promising and less invasive treatment option, its success relies heavily on the surgeon's experience and understanding of the skull base anatomy, stressing the need for careful approach selection.