摘要
前顱底前界為額竇後壁（frontal sinus posterior table），後界為蝶骨平台（planum sphenoidale），外側界為眼眶紙狀板（lamina papyracea），中央天花板由篩狀板（cribriform plate）與篩骨雞冠（crista galli）構成，經傾斜之lateral lamella向外連接至篩竇頂／篩竇小窩（ethmoid roof/ fovea ethmoidalis），下方則有垂直板（perpendicular plate）與犁骨（vomer）接合形成鼻中膈的骨質部。前顱底兩條主要血管，前篩動脈（anterior ethmoid artery）可在額竇開口後緣，或是suprabullar ethmoidal cell後緣辨認，後篩動脈（posterior ethmoid artery）位於蝶骨平台與篩狀板交界。移除篩狀板與腦膜後，前顱窩內可見額葉、前腦動脈分支、兩側嗅球（olfactory bulb）、大腦鐮（falx cerebri）連接至篩骨雞冠。內視鏡前顱底手術，依照病灶位置與手術需求，在矢狀平面由前往後可分為三個路徑，（1）經額竇路徑（transfrontal approach）（2）經篩狀板路徑（transcribriform approach）（3）經蝶骨平台路徑（transplanum approach）。術前必須依照病理切片、腫瘤分期、影像學檢查、團隊支援，來思考內視鏡下手術路徑與重建計畫，始能得到最好的手術成果。本文中就前顱底解剖、內視鏡經鼻手術路徑與傷口重建做探討。
並列摘要
The anterior skull base is bounded anteriorly by the posterior table of the frontal sinus, posteriorly by the planum sphenoidale, and laterally by the lamina papyracea or orbital medial wall. The cribriform plate and crista galli form the midline structure of the anterior skull base, which allows passage of the olfactory nerve filaments that enter the nasal cavity. The lateral lamella attaches the cribriform plate to the ethmoid roof or fovea ethmoidalis. Removal of the cribriform plate and dura facilitate visualization of the olfactory bulb and tract on the ventral aspect of the frontal lobe, and the falx cerebri is formed by fusion of the dura that attaches to the crista galli. Two major arteries run across the roof of the ethmoid; the anterior ethmoidal artery usually courses along the posterior border of the frontal recess or along the posterior edge of the suprabullar ethmoidal cells, and the posterior ethmoidal artery is observed at the junction of the planum sphenoidale and the cribriform plate. Compared with conventional craniofacial resection, a variety of routes including the transfrontal, transcribriform, and transplanum approaches are available for endoscopic endonasal resection of anterior skull base tumors. However, preoperative evaluation of the pathology, tumor stage, intracranial extension, and reconstruction strategy are important to determine the appropriateness of pure endoscopic surgery. In this article, we review the surgical anatomy of the anterior skull base, endoscopic endonasal approaches, and reconstruction considerations.