Endoscopic Surgery for Skull Base Meningiomas

Abstract

Endoscopic surgery within the paranasal sinuses began in the early 1900s, however Gerald Guiot was the first neurosurgeon to apply endoscopy during a transsphenoidal approach performed in 1963 [2, 10]. The development of rod lens systems by Harold Hopkins greatly accelerated the introduction of endoscopes into the operating room [8]. By the late 1970s, several neurosurgeons had reported on the endoscope as an adjunctive tool during microscopic resection of pituitary lesions with extrasellar extension [1, 4, 7, 9]. Yet, the endoscope did not outgrow its peripheral role in neurosurgery until the early 1990s when Jankowski and colleagues first described pure endoscopic transsphenoidal approaches to the sella [12]. More recently, Paulo Cappabianca and Luigi Cavallo have helped lead the popularization of a purely endoscopic transsphenoidal approach [3]. A critical point in the history of endonasal surgery has been the recent introduction of vascularized nasoseptal flaps for reconstruction. The nasoseptal flap has greatly reduced the morbidity of endoscopic skull base surgery and has made the endonasal resection of extrasellar skull base tumors, such as meningiomas, feasible [11, 16].