Chapter 3064 【3064】Just Right
In neurosurgery, the brain is dealt with, so the surgical approach through the nose and sphenoid sinus is vividly called the nasal sphenoid approach.
The nasal sphenoid approach is definitely a minimally invasive surgery. Like other minimally invasive surgery in neurosurgery, it uses a small opening leading to the inside of the brain.
Minimally invasive surgery has the limitations of minimally invasive surgery, which we have already mentioned in the case of parasite removal last time. Theoretically speaking, after the surgical instrument enters through the small incision, a roughly conical limit surgical area will be formed through this opening. Beyond the limit area, the instrument cannot reach and the operation cannot be performed.
For nasal sphenoidal approach surgery, the central area of the best surgical area is the central area where the sphenoid sinus enters, and the sella area we mentioned at the beginning is called again.
The surgical area that can be treated by nasal sphenoid surgery basically revolves around the sellar area. In addition to the saddle area, for some lesions in the suprasellar area near the sellar area, the parasellar area, the slope area, etc., the doctor will try his best to help the patient with surgery if he can see it with the nasal speculum.
Surgery through the nose without craniotomy or even a hole, leaving no scars. It definitely sounds like a better surgical approach than minimally invasive hole punching. Patients are definitely going to like this kind of surgery the most.
Not to mention patients, doctors like it just as much.
What I like is not the trouble of opening the hole or not, but that if the doctor does not go from the nose, if the doctor wants to open the patient's skull for surgery, he can only start from the top and sides of the head. These surgical approaches are not without exception. The paths they go through are relatively long, and they have to pass through a lot of brain tissue, and they cannot bypass the important area of the eye.
Neurosurgery, as we said before, is most afraid of inadvertently injuring other normal brain tissues and neurovascular organs during the operation. It is the best surgical method. Therefore, the three-dimensional positioning of neurosurgery has been mentioned as the most important point many times.
Looking at it this way, patients with nasal sphenoid surgery want to be doctors and want to do it. Whether they can do it or not depends on the patient's condition, which is also the luck of the patient. See if the tumor can grow just enough to be within the reach of surgical instruments under the doctor's nose.
The most appropriate tumor to grow in this place should be a pituitary adenoma, because the pituitary gland is located in the sella region. The best indication for nasal sphenoid surgery is a well-proportioned pituitary adenoma.
Another type of tumor that is more appropriate is craniopharyngioma. The craniopharynx is a structure that connects the adenohypophysis and the pharynx and then degenerates and disappears. Therefore, most of the tumors that grow here are benign tumors caused by congenital factors. It is related to the pituitary gland, so it is naturally an operation that can be performed on the pituitary gland. As long as it grows in a suitable position, it can also be performed through the nasal sphenoid approach.
Since the surgical area of the transnasal sphenoidal approach is too limited, if the tumor just grows a little beyond the surgical area, what should I do if I really want to continue to use the nasal sphenoidal approach? Is there a more flexible way to solve it?
In surgery, it is common to find that the operative field is just a little smaller after entering it. As we have said in countless previous cases, the simple and most effective way to expand the operative field is to enlarge the incision.
It is the same principle in the nasal sphenoidal approach surgery. The sphenoid sinus is widened again, which is called enlarged sphenoid sinus incision, and the sphenoid mucosa and part of the posterior ethmoid sinus are removed.
At this point in the conversation with the patient, Fang Zeren in the next room could finally hear Dr. Tong's voice, and the people from the National Association of China pricked up their ears to listen.