[Extended endoscopic endonasal approach to skull base]

Area of Science:

• Neurosurgery
• Otolaryngology
• Endocrinology

Background:

• Skull base surgery traditionally involves open approaches.
• The trans-sphenoidal sinus route offers endoscopic access to the skull base.
• Extended endoscopic endonasal approach (EEA) expands traditional boundaries.

Purpose of the Study:

• To review the experience with the extended endoscopic endonasal approach (EEA) in 127 patients.
• To analyze the types of skull base lesions treated.
• To evaluate surgical outcomes and complications.

Main Methods:

• Retrospective review of 127 patients undergoing EEA.
• Data collected on lesion type, surgical approach, resection rates, and complications.
• Specific focus on invasive adenomas, chordomas, craniopharyngiomas, meningiomas, CSF leaks, meningoencephalocele, malignant lesions, and thyroid ophthalmopathy.

Main Results:

• Gross total resection achieved in 82.5% of tumoral lesions.
• High resection rates for craniopharyngiomas (90.5%), invasive adenomas (85.2%), and meningiomas (84.6%).
• Most frequent complications included diabetes insipidus (8.6%), meningoencephalitis (3.9%), and hydrocephalus (3.9%); mortality was 3.9%.

Conclusions:

• EEA is a promising minimally invasive alternative for select skull base lesions.
• Advancements in techniques and technology may establish EEA as a primary surgical option.
• EEA should be considered by skull base surgeons for managing complex pathologies.