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Updated: May 25, 2026
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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Endoscopic skull base surgery: a comprehensive comparison with open transcranial approaches
Ricardo J Komotar1, Robert M Starke, Daniel M S Raper
1Department of Neurological Surgery, University of Miami, Miami, FL, USA.
British Journal of Neurosurgery
|February 14, 2012
Summary
Endoscopic endonasal surgery offers comparable or better tumor removal for many anterior skull base conditions compared to traditional open surgery. However, open approaches remain superior for meningiomas, with higher CSF leak rates in some endoscopic procedures.
Area of Science:
- Neurosurgery
- Otolaryngology
- Skull Base Surgery
Background:
- Limited comparative data exists for endoscopic endonasal approaches versus traditional open techniques for anterior skull base pathology.
- Endoscopic endonasal surgery (EES) is increasingly utilized, necessitating a clear understanding of its outcomes relative to established methods.
Purpose of the Study:
- To systematically review and compare surgical and clinical outcomes of EES with transcranial and transsphenoidal microscopic approaches for anterior skull base pathologies.
- To characterize the efficacy and safety of EES in managing diverse skull base tumors.
Main Methods:
- Systematic review of case series and case reports.
- Analysis of surgical outcomes, including rates of gross total resection (GTR).
- Evaluation of postoperative complications, specifically cerebrospinal fluid (CSF) leak rates.
Main Results:
- EES demonstrated equivalent or higher GTR rates than open approaches for craniopharyngiomas, clival chordomas, esthesioneuroblastomas, and giant pituitary adenomas.
- Open transcranial approaches achieved higher GTR rates for meningiomas.
- CSF leak rates were higher with EES for meningiomas and craniopharyngiomas, but not for chordomas, esthesioneuroblastomas, or giant pituitary adenomas.
Conclusions:
- EES is a safe and effective alternative for treating various anterior skull base pathologies, especially midline tumors.
- The choice of surgical approach should consider tumor type and location to optimize resection rates and minimize complications.
