Overview - Endoscopic Skull Base Surgery
Introduction:
Endoscopic skull base surgery has revolutionized the field of neurosurgery and otolaryngology by offering minimally invasive approaches to lesions located at the skull base. This sub-specialty within the broader scope of neurosurgery and otolaryngology focuses on utilizing endoscopic technology to access and treat lesions, tumors, and abnormalities situated in the intricate anatomy of the skull base. Advanced techniques in endoscopic skull base surgery require a deep understanding of anatomy, meticulous surgical skills, and innovative approaches to manage complex pathologies effectively. In this sub-specialty content, we delve into the nuances and advancements within endoscopic skull base surgery, highlighting key procedures, technological innovations, and emerging trends shaping the field.
Key Procedures:
1. Endoscopic Endonasal Approach (EEA):
- The cornerstone of endoscopic skull base surgery, EEA provides access to lesions located in the anterior and central skull base.
- Allows surgeons to reach areas such as the pituitary gland, anterior skull base, sella turcica, and parasellar region through the nasal passages, avoiding external incisions.
- Applications include resection of pituitary adenomas, craniopharyngiomas, meningiomas, and chordomas.
Extended Endoscopic Approaches:
- Utilizing advanced techniques, such as angled endoscopes and skull base reconstruction, surgeons can extend the reach of endoscopic approaches to complex lesions involving the anterior cranial fossa, clivus, and infratemporal fossa.
- Techniques like the endoscopic transpterygoid approach enable access to the lateral skull base, allowing resection of tumors such as juvenile nasopharyngeal angiofibromas and parapharyngeal space tumors.
Combined Approaches:
- Integration of endoscopic techniques with traditional neurosurgical or otolaryngological approaches, such as the transcranial-transsphenoidal approach, expands the surgical armamentarium for complex lesions requiring multi-dimensional access.
- Combined approaches offer improved visualization and tumor removal while minimizing surgical morbidity.
