医学
蝶鞍
鞍结节
海绵窦
垂体腺瘤
经蝶手术
第三脑室
冠状面
放射科
腺瘤
外科
脑膜瘤
解剖
病理
作者
Ryota Tamura,Hirotaka Oda,Kenzo Kosugi,Masahiro Toda
出处
期刊:Operative Neurosurgery
[Oxford University Press]
日期:2022-07-11
卷期号:23 (4): e276-e282
被引量:1
标识
DOI:10.1227/ons.0000000000000339
摘要
BACKGROUND: Transsphenoidal endoscopic endonasal surgery (EES) provides effective treatment for patients with lesions of the sella turcica. The endoscopic technique requires different instrumentation, which depends on the gross anatomy of the nasal cavity. The treatment of lateral lesions is more challenging in EES. OBJECTIVE: To evaluate the effect of preoperative simulation using multiple anatomic landmarks. METHODS: Pre- and postoperative tumor volumes were analyzed in 33 patients with nonfunctioning pituitary adenomas who underwent EES (Knosp grades 3 and 4). The surgical working angle and space were three-dimensionally simulated at the plane of the anterior/posterior surgical field (tuberculum sellae/posterior clinoid process) using multiple anatomic landmarks of high-resolution computed tomography scans, such as nasal piriform aperture (proximal surgical corridor), and the width of bilateral vidian canals or lamina perpendicularis of palatine bone (distal surgical corridor). Receiver operating characteristic curves for the removed tumor volume were used to determine the cutoff value for the simulated working angle and space. RESULTS: Simulated working space at the plane of tuberculum sellae using piriform aperture and lamina perpendicularis of palatine bone was associated with the removed tumor volume in the cavernous sinus. Patients with a larger working space (≥42.7 mm) significantly showed a higher removed tumor volume ( P = .023). There was no relationship between other parameters and the removed tumor volume. CONCLUSION: A new method to predict the surgical field for cavernous sinus lesions around sella turcica was successfully established. Further studies are needed to define and expand applications of this simulation method.
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