The expanding role of endoscopic skull base surgery

The endoscopic endonasal approach (EEA) is a surgical technique where a small aperture, the nostrils, can give access to the whole ventral skull base. Its principles differ from the ones of traditional skull base approaches where a wide external opening is often accompanied by a relatively small working area. Most of the results of EEAs published in the literature come from retrospective case series and the follow-up is still limited, however the consensus is that this technique is safe and effective in selected cases and when performed within dedicated skull base centres. This article sets to give an overview of the current state of endoscopic skull base surgery, based on the recent evidence and our centre's experience with nearly 2000 EEAs. The team's experience with endoscopic as well as open approaches plays a critical role in achieving satisfactory results when treating pathologies of the skull base. Guided by the principle of least neural and vascular manipulation, the team should be able to select the least traumatic route (open or endoscopic) and be able to approach the skull base from all angles.