Extended endoscopic endonasal approach to skull base

Objective: Different approaches to the skull base have been developed through the sphenoidal sinus. Traditional boundaries of the trans-sphenoidal approach can be extended in antero-posterior and lateral plane. We review our experience with extended endoscopic endonasal approach in 127 cases.

Methods: We used the extended endoscopic endonasal approach in 127 patients with different lesions of the skull base. This study specifically focuses on: type of lesions, surgical approach, outcome and surgical complications.

Results: Extended endoscopic endonasal approach was used in 127 patients with following lesions: 61 invasive adenomas to cavernous sinus, 10 clival chordomas, 21 craniopharyngiomas, 26 meningiomas, 4 cerebrospinal fluid leakages, one meningoencephalocele, 2 malignan lesions and 2 thyroid ophthalmopathy. In tumoral lesions gross total resection was achieved in 82.5%, with better results in craniopharyngiomas 90.5%, followed by invasive adenomas with 85.2%, and meningiomas with 84.6%. The most frequent complications were the insipid (8.6%) diabetes, meningoencefalitis (3.9%) and the hydrocephalic (3.9%). Mortality was 3.9%.

Conclusions: The extended endoscopic endonasal approach is a promising minimally invasive alternative for selective cases with skull base lesions. As techniques and technology advance this approach may become the procedure of choice for most lesions and should be considered an option in the management of the patients with these complex pathologies by skull base surgeon.