第16回日本神経内視鏡学会 抄録
The 16th Annual Meeting of the Japanese Society for Neuroendoscopy

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第1日目、12月4日(金)A 会場(3階 メインホール) 12:10〜12:50

ランチョンセミナー 1

座長: 嘉山孝正

1A-LS1

Giorgio Frank 先生の顔写真

Endoscopy in Italy and in Bologna

Giorgio Frank 先生

Centre of Endoscopic Skull Base Surgery, Bellaria Hospital Bologna, Italy

The endoscope is an optic instrument that allows clear and wide vision of the operating field through narrow operative channels. Furthermore, angled endoscopes allow the vision "behind the corner", making visible what it is impossible to see with naked eye, operating microscope or 0° endoscope. The endoscope may be the unique optical device used for surgery ("pure" endoscopic surgery). Furthermore, the neurosurgeon may use endoscopy as a complement to microscopic surgery (endoscopic controlled or assisted microscopic surgery).

Nowadays neurosurgeons are much aware of the safety and effectiveness of endoscopy than they used to be. A useful way to think about endoscopy is to recognize that very likely there is no neurosurgical OR lacking an endoscopic apparatus in Italy. In general, endoscopic controlled neurosurgery is one of the most commonly performed surgical procedures, for example in aneurysm surgery to better view the parents arteries or in acoustic neuroma to control the deep of the acoustic meatus. On the other hand, transventricular endoscopy is perhaps the most common use of a "pure" endoscopic neurosurgery for carrying out ventriculo-cysternostomy, biopsies and treatment of colloid cysts or other cystic lesions accessible through the ventricles.

The use of the endoscope, instead of the microscope, permits the introduction of surgical instruments in parallel with the endoscope. This approach is possible in different neurosurgical procedures, but the widest application is very likely the endoscopic endonasal skull base surgery. The use of this technique is increasingly reported. There are many excellent centres in Italy ( i.e. Neaples, Bologna, Varese, Pavia). With the exception of the group in Neaples, the others groups have developed by a strict cooperation between neurosurgeons and ENT surgeons just trained in the endoscopic technique for the FESS. Furthermore, the endoscopic technique, which is a video surgery, facilitates both teaching and learning per se. What's more, performing anatomical dissections is extremely difficult in Italy. Taken together, these facts may further explain why young neurosurgeons are more interested in the endoscopic techniques than the traditional surgical approaches.

In Bologna a tradition exists on the treatment of pituitary disease. Prof Cavina (1932) reported one of the first series of patients affected by pituitary adenomas treated by a transsphenoidal approach. Prof F. Columella performed his first microscopic transsphenoidal surgery in 1969. In 1975 I began my experience using the microscopic transsphenoidal approach, and in 1998 I switched from the microscopic to the "pure" endoscopic technique. Since that time the applications of the endoscopic endonasal techniques have been extended from the pituitary surgery to a real skull base surgery. At present, at the Department of Neurosurgery of the Bellaria Hospital a section dedicated to the Endoscopic Skull Base Surgery exists. I am the Director of the Centre and one trained neurosurgeon and one resident cooperate with me. Many other specialists actively participate to my work, so that I can say that the Centre I coordinate is actually a multidisciplinary team. We perform more than 100 procedures yearly. The scientific activity consists of articles on international scientific journals, participation to many meetings in Italy and all around the world, and organization of workshops. Over the last decade, we have organized an international workshop in Bologna every year with alternate theoretical lessons and live surgery. Likewise, we have just organized in Granada a workshop with alternate theoretical lessons and hands-on dissections.

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