Endoscopic Skull Base Surgery: Anatomical Basis of Skull Base Approaches

Abstract

One of the most exciting and challenging fields in otorhinolaryngology is the rapidly evolving multidisciplinary skull base surgery. The discipline of endoscopic skull base surgery has progressed profoundly in the past several decades due to developments in imaging, instrumentation, and endoscopic techniques. Today, endoscopy was adopted largely for endonasal surgery by the assistance of cameras and high-technology video systems. Neurosurgeons also began to use these new endoscopes as an adjunct to microscope particularly for the resection of pituitary and parasellar lesions. However, when the microscope is on the field, the speculum limits the working space and the maneuverability of the endoscope and instruments. Understanding the inside-out endoscopic anatomy of anterior skull base, development of imaging and navigation technologies, and refinement of surgical instruments enabled four-hands, two-team approach for endoscopic skull base surgery. Both of these developments finally came together in the 1990s when the first multidisciplinary endoscopic skull base teams were formed. Endoscopic endonasal surgery has now become an invaluable surgical modality by which several pathologies of the skull base can be approached and treated. It offers a direct route for accessing the anterior, middle, and posterior cranial fossa. It has been shown to be safe and effective; however, it requires a detailed understanding of the intricate anatomy to be successful.