Endoscopic endonasal skull base surgery: past, present and future (original) (raw)
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The expanded endoscopic endonasal approaches for the skull base
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2018
Background: Endoscopic endonasal approach (EEA) for skull base surgery (SBS) is a significant modification of the current practice. Methods: We reviewed our experience at the University of Pittsburgh with EEAs for 800 patients from 1998 to July 2007. Results: Modular approaches to multiple pathologies of the skull base were designed totally based on intrinsic anatomy. Stages of training were established based on the level of technical difficulty and potential risk of vascular and neural injury. Five levels were defined in an incremental manner. Conclusions: Practice standardization with modular, incremental training is projected to facilitate the gaining of knowledge and skills to safely master EEAs for SBS in an organized manner. We suggest adherence to the systematic acquisition of endoscopic skills, to work as an integrated team of surgeons and to have a thorough perspective of conventional SBS and endoscopic surgery. Therefore, the choice of approach must be a specific function ...
Indications and limitations of endoscopic skull base surgery
A wealth of critical neurovascular structures within a relatively small surface area adds to the already intricate nature of skull base surgery. Surgical approaches to the area are difficult and often associated with significant morbidity and mortality. During the past two decades, endoscopic endonasal approaches (EEAs) have evolved to access the ventral skull base for the resection of tumors (benign and malignant), the decompression of neural structures including the cervicomedullary junction (pannus from rheumatoid arthritis or congenital anomalies, such as platybasia) and the reconstruction of skull base defects (cerebrospinal leaks, meningoencephalocele). These minimal access approaches obviate the need for external incisions, translocation of maxillofacial bones and retraction of the brain. Furthermore, EEAs yield improved visualization, which may reduce complications, and improve quality of life outcomes. Anatomical difficulties (e.g., vascular encasement or extension beyond the plane of a major vessel or cranial nerve), various special conditions (e.g., pediatric patients and vascular tumor) and limitation of institutional resources and technical difficulties may limit the use of EEAs. Thus, one should understand the indications and limitations of EEAs to optimize patient selection, which, in turn, may lead to superior surgical outcomes and reduced morbidity.
Endoscopic approach to the anterior skull base
Operative Techniques in Otolaryngology-Head and Neck Surgery, 1995
Today, endoscopic endonasal operations have become daily � outine in ENT-surgery, particularly endonasal sur gery m cases of chronic polyposis of the paranasal si nuses. Younger ENT surgeons become familiarized with these endonasal techniques during their training. On the other hand, the number of operative procedures on the p � ranasal s _ inuses via the possible external ap proaches I S decreasmg because a growing number of dis eases can be treated by modern endonasal techniques. � odern suction-irrigation endoscopes, combined with a high performance endocamera (chip camera) provide a clear vision in the operative field. This allows the sur geon t � work quite safely inside the nose and the para nas � l smuses, as well as near to the posterior part of the orbit and the frontal skull base. Working under vi deoendoscopic control is especially safer for the less ex perienced � urg � on because s ': lpervision of every step of the operation I S easy to achieve. Many patients with chronic polyosis of the sinuses are resistant to conserva tive drug treatment and depending on the amount of polyposis, are typically treated by endonasal operations, sue� as partial ethmoidectomy or complete sphenoeth mmdectomy. However, during the last few years more cond�tions involving the frontal skull base or the parana sal smuses are treated by endoscopic approaches.I-4
Endonasal surgery of the ventral skull base--endoscopic transcranial surgery
Oral and maxillofacial surgery clinics of North America, 2010
Skull base surgery is evolving from traditional transfacial and transcranial approaches to the endoscopic endonasal approach, a less intrusive corridor for accessing the ventral skull base. This technique eliminates facial scars, expedites recovery, and obviates brain retraction. The goals of surgical excision, whether palliative or curative, are identical: an approach that is less disruptive to normal tissues. By exploiting the sinonasal corridor, the entire ventral skull base may be accessed to successfully treat benign and malignant lesions. The expanding limits of endoscopic skull base surgery have been accompanied by commensurate innovations in reconstructive techniques that are reliable and have been shown to limit postoperative complications. This article describes the basis for this approach and provides the latest outcome data supporting the current state of the art for endoscopic skull base surgery.
Endoscopic Endonasal Anatomy and Approaches to the Anterior Skull Base
Journal of Craniofacial Surgery, 2010
Objectives: The objective of this study was to review the endoscopic anatomy of the anterior skull base, defining the pitfalls of endoscopic endonasal approaches to this region. Recently, these approaches are gaining popularity among neurosurgeons, and the details of the endoscopic anatomy and approaches are highlighted from the neurosurgeons' point of view, correlated with demonstrative cases. Materials and Methods: Twelve fresh adult cadavers were studied (n = 12). We used Karl Storz 0 and 30 degrees, 4 mm, 18-and 30-cm rod lens rigid endoscope in our dissections. After preparation of the cadaveric specimens, we approached the anterior skull base by the extended endoscopic endonasal approach. Results: After resection of the superior portion of the nasal septum, bilateral middle and superior turbinates, and bilateral anterior and posterior ethmoidal cells, we could obtain full exposure of the anterior skull base. The distance between optic canal and the posterior ethmoidal artery ranged from 8 to 16 mm (mean, 11.08 mm), and the distance between posterior ethmoidal artery and the anterior ethmoidal artery ranged from 10 to 17 mm (mean, 13 mm). After resecting the anterior skull base bony structure and the dura between the 2 medial orbital walls, we could visualize the olfactory nerves, interhemispheric sulcus, and gyri recti. With dissecting the interhemispheric sulcus, we could expose the first (A1) and second (A2) segments of the anterior cerebral artery, anterior communicating artery, and Heubner arteries. Conclusions: This study showed that extended endoscopic endonasal approaches are sufficient in providing wide exposure of the bony structures, and the extradural and intradural components of the anterior skull base and the neighboring structures providing more controlled manipulation of pathologic lesions. These approaches need specific skill and learning curve to achieve more minimally invasive interventions and less postoperative complications.
Clinical and experimental otorhinolaryngology, 2008
Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field.
Skull Base Endoscopic-Assisted Surgery
Endoscopy - Innovative Uses and Emerging Technologies, 2015
Endoscopic-assisted surgery is becoming a more and more important tool in the neurosurgical armamentarium. This chapter provides a broad overview of the role of this technique in various skull base procedures. It starts with a historical perspective followed by a thorough exploration of the various principles and techniques for different indications. Additionally, the topics of "minimally invasive" techniques using "key hole" approaches are explained. At the end of this chapter, advantages and pitfalls with endoscopic assisted techniques are discussed.
Endoscopic endonasal skull base surgery
European annals of otorhinolaryngology, head and neck diseases, 2012
Skull base surgery has been transformed by the development of endoscopic techniques. Endoscopic procedures were first used for pituitary surgery and were then gradually extended to other regions. A wide range of diseases are now accessible to endoscopic skull base surgery. The major advantage of the endoscopic endonasal approach is that it provides direct anatomical access to a large number of intracranial and paranasal sinus lesions, avoiding the sequelae of a skin incision, facial bone flap or craniotomy, and brain retraction, which is inevitable with conventional neurosurgical incisions, resulting in decreased morbidity and mortality and, indirectly, decreased length of hospital stay and management costs. Moreover, the increasing number of publications in this field illustrates the growing interest in these techniques. This paper provides a review of endoscopic skull base surgery. The indications and general principles of endoscopic endonasal skull base surgery are described. Pro...
Anatomy and surgery of the endoscopic endonasal approach to the skull base
Translational medicine @ UniSa, 2012
The midline skull base is an anatomical area, which extends from the anterior limit of the anterior cranial fossa down to the anterior border of the foramen magnum. For many lesions of this area, a variety of skull base approaches including anterior, antero-lateral, and postero-lateral routes, have been proposed over the last decades, either alone or in combination, often requiring extensive neurovascular manipulation. Recently the endoscopic endonasal approach to the skull base has been introduced to access the midline skull base. The major potential advantage of the endoscopic endonasal technique is to provide a direct anatomical route to the lesion since it does not traverse any major neurovascular structures, thereby obviating brain retraction. The potential disadvantages include the relatively restricted exposure and the higher risk of CSF leak. In the present study we report the endoscopic endonasal anatomy of different areas of the midline skull base from the olfactory groove...