A Multicorridor 360 Degree Strategy(<SPECIAL ISSUE>Skull Base Surgery in the Radiosurgery Era)

概要

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Excessive morbidity related to extensive skull base approaches is unfortunately still widely encountered around the world. There is a global tendency for less aggressive approaches in order to minimize surgical morbidity in skull base surgery. The main concern associated with this trend is related to the ability of maintaining surgical effectiveness and respecting oncological principles while trying to reduce tissue exposure, manipulation and disruption. Endoscopic endonasal surgery has enabled surgeons to reach skull base lesions beyond the sella turcica avoiding facial incisions and craniotomies. The expanded endonasal approaches (EEA) safely provide access along the sagittal and coronal plane to the anterior, middle and posterior cranial fossa with minimal neural tissue manipulation. Skull base surgeons should be able to recognize when a transcranial, endonasal, or a combination of such approaches is best suited for a specific patient. A multicorridor 360 degree strategy is favored to treat skull base lesions, in which the most direct and least destructive route or routes are chosen in order to facilitate the most complete resection with less morbidity possible. This manuscript details the foundations of the 360-degree concept and provides an overview of the most commonly used transcranial approaches and endonasal approaches that similarly enable to reach the anterior, middle and posterior fossa.
2011-03-20