Extended endoscopic approaches for midline skull-base lesions

Area of Science:

• Neurosurgery
• Endoscopic Surgery
• Skull Base Surgery

Background:

• The endoscopic transsphenoidal approach is a recognized technique for sellar and parasellar lesions.
• Endoscopes provide a panoramic view, surpassing the limitations of microscopic approaches.
• Angled-lens endoscopes facilitate access to sellar, parasellar, and suprasellar compartments.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the extended endoscopic endonasal transsphenoidal approach.
• To assess the feasibility of this extended technique in a diverse range of skull base pathologies.
• To document the extent of tumor removal and potential complications associated with the procedure.

Main Methods:

• Retrospective analysis of 13 patients undergoing extended endoscopic endonasal transsphenoidal approach over five years.
• Detailed review of tumor types, extent of resection, and postoperative complications.
• Comparison of endoscopic approach benefits (panoramic view, no brain retraction) versus microscopic limitations.

Main Results:

• Total tumor removal was achieved in 9 out of 13 patients; subtotal removal in 4.
• The extended approach was utilized for various tumors including pituitary adenoma, craniopharyngioma, chordoma, and meningioma.
• The technique allows access from the lamina cribrosa to the cranio-cervical junction without significant neurovascular manipulation.

Conclusions:

• The extended endoscopic endonasal transsphenoidal approach is crucial for accessing extensive skull base regions.
• This minimally invasive technique enables tumor resection without brain retraction.
• Challenges include managing intracranial vessel hemorrhage and closing dural defects to prevent cerebrospinal fluid leaks and meningitis.