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2日目、12月5日(土)A 会場(3階 メインホール) 10:00〜10:40

特別講演 3

座長: 河瀬 斌

2A-SL3

Giorgio Frank 先生の顔写真

Endoscopic endonasal surgery: from the sella to the skull base

Giorgio Frank 先生

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

Pure endoscopic transsphenoidal pituitary surgery was first performed by Jankowski et al. (1992) [6] who treated three patients affected by pituitary adenomas. Five years later, a large series of pituitary adenomas was reported in the Journal of Neurosurgery by Jho and Carrau [7]. Our experience began after this date and was first focused on the treatment of expanding processes of the sella. We reported our results regarding the endoscopic treatment of pituitary adenomas in 2006 concluding that the endoscopic technique in microadenomas allows results comparable to the microscopic technique but, in macroadenomas, we found an improvement in tumour removal [3]. Since the beginning, due to the ability of the endoscope to allow a wide panoramic and a close-up view of deep surgical fields, it appeared that, by using expanded endoscopic transsphenoidal approaches, even lesions outside the sella became accessible. Over the last decade, the advent of extended endoscopic approaches expanded endoscopic endonasal surgery from a sellar pathology to skull base surgery. We have utilized the expanded transtuberculum-transplanum approach mainly for craniopharyngiomas, even those purely suprasellar [2]. The results are encouraging suggesting that it is the best technique for this approach. The extended transclival approach was mainly used for chordomas and chondrosarcomas [5]. The results are comparable or better than the results previously obtained with open and more invasive approaches. Our interest was also applied to the parasellar area [1, 2, 5]; long experience with endoscopic endonasal cavernous sinus surgery allows us to disagree with the prevailing philosophy of avoiding from cavernous sinus surgery. An endonasal odontoidectomy is seldom required; we have operated on and reported a rare case in a paediatric patient [8]. The excellent result obtained convinced us that this procedure represents the best alternative to a transoral odontoidectomy

In conclusion, our experience with endoscopic endonasal surgery suggests that, notwithstanding its limits, it allows a minimally invasive approach, preserving safety and effectiveness of the procedure. It is our belief that it should be taught to young neurosurgeons because it is part of the armamentarium of skull base surgeons.

  1. Frank G, Pasquini E Approach to the cavernous sinus in Endoscopic endonasal transsphenoidal surgery, de Divitiis E, Cappabianca P (eds), Springer Wien New York, 159-175,2003.
  2. Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G, Calbucci F.The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery. 2006 Jul;59(1 Suppl 1)
  3. Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M. The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology. 2006;83(3-4):240-8.
  4. Frank G, Pasquini E. Endoscopic endonasal cavernous sinus surgery, with special reference to pituitary adenomas Front Horm Res. 2006;34:64-82.
  5. Frank G, Sciarretta V, Calbucci F, Farneti G, Mazzatenta D, Pasquini E. The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery. 2006 Jul;59(1 Suppl 1)
  6. Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M. Endoscopic pituitary tumor
  7. Jho HD, Carrau RL. J Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. Neurosurg. 1997 Jul;87(1):44-51. Laryngoscope. 1992 Feb;102(2):198-202
  8. Magrini S, Pasquini E, Mazzatenta D, Mascari C, Galassi E, Frank G.Endoscopic endonasal odontoidectomy in a patient affected by Down syndrome: technical case report. Neurosurgery. 2008 Aug;63(2):E373-4; discussion E374.
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