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Updated: May 7, 2026
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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Initial experiences with endoscopic rhino-neurosurgery in Amsterdam
Rick de Bruin1, Wouter R van Furth, Dagmar Verbaan
1Department of neurosurgery, Academic Medical Centre, Amsterdam, The Netherlands, rickdb82@gmail.com.
Summary
Endoscopic skull base surgery using the "two nostrils-four hands technique" is safe and effective for various tumors. This approach achieved high resection rates with manageable complications like CSF leakage.
Area of Science:
- Neurosurgery
- Otorhinolaryngology
- Endoscopic Surgery
Background:
- Endoscopic skull base surgery is increasingly utilized.
- It offers access from the anterior frontal sinus to the posterior odontoid process.
- The
- two nostrils-four hands technique
- allows visualization and instrument manipulation through a single nasal corridor.
Purpose of the Study:
- To evaluate the safety and efficacy of the endoscopic
- two nostrils-four hands technique
- for skull base tumors.
- To assess resection rates and complications in a retrospective case series.
Main Methods:
- Retrospective study of 67 patients operated between 2008 and 2012.
- Inclusion criteria: pituitary tumors extending beyond the sella, sinonasal tumors, and non-pituitary skull base tumors.
- Data collected from otorhinolaryngology and neurosurgery databases.
Main Results:
- Near-to-gross total resection achieved in 92% of intended total resections.
- Mean tumor diameter was 3.8 cm.
- The most frequent complication was cerebrospinal fluid (CSF) leakage.
Conclusions:
- The endoscopic
- two nostrils-four hands technique
- is a safe and reliable method for skull base tumor resection.
- Successful implementation requires a multidisciplinary team including anesthesiology, endocrinology, ophthalmology, and radiation oncology.
