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Endoscopic transnasal skull base surgery: pushing the boundaries

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Abstract

The endoscopic endonasal approach (EEA) has significantly evolved since its initial uses in pituitary and sinonasal surgery. The literature is filled with reports and case series demonstrating efficacy and advantages for the entire ventral skull base. With competence in ‘minimally invasive’ parasellar approaches, larger and more complex approaches were developed to utilize the endonasal corridor to create maximally invasive endoscopic skull base procedures. The challenges of these more complex endoscopic procedures include a long learning curve and navigating in a narrow corridor; reconstruction of defects presented new challenges and early experience revealed a significantly higher risk of cerebrospinal fluid leak. Despite these challenges, there are many benefits to the EEA including avoidance of brain and neurovascular retraction, improved visualization, a direct corridor onto many tumors and the two-surgeon approach. Most importantly, the EEA provides a midline corridor to directly access tumors, which displace critical neurovascular structures laterally, giving it an inherent advantage of minimizing any manipulation of these structures and thus decreasing their potential injury.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Nathan T. Zwagerman, Georgios Zenonos, Stefan Lieber, Wei-Hsin Wang, Juan C. Fernandez-Miranda, Carl H. Snyderman & Paul A. Gardner

  2. Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Eric W. Wang & Carl H. Snyderman

  3. UPMC Center for Cranial Base Surgery, 200 Lothrop Street, PUH B-400, Pittsburgh, PA, 15213, USA

    Eric W. Wang, Juan C. Fernandez-Miranda, Carl H. Snyderman & Paul A. Gardner

Authors
  1. Nathan T. Zwagerman
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  2. Georgios Zenonos
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  3. Stefan Lieber
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  4. Wei-Hsin Wang
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  5. Eric W. Wang
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  6. Juan C. Fernandez-Miranda
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  7. Carl H. Snyderman
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  8. Paul A. Gardner
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Corresponding author

Correspondence to Paul A. Gardner.

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Zwagerman, N.T., Zenonos, G., Lieber, S. et al. Endoscopic transnasal skull base surgery: pushing the boundaries. J Neurooncol 130, 319–330 (2016). https://doi.org/10.1007/s11060-016-2274-y

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  • DOI: https://doi.org/10.1007/s11060-016-2274-y

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