Combination of Endoscopic Endonasal and Transcranial Approaches: Rationale, Strategies and Outcomes

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Complex skull base lesions present challenges in surgical approach selection.
• Combined endoscopic endonasal and transcranial strategies are understudied for these pathologies.

Purpose of the Study:

• To analyze the experience with combined endoscopic endonasal and transcranial approaches for complex skull base lesions.
• To compare simultaneous versus staged combined approaches regarding outcomes and complications.

Main Methods:

• A retrospective analysis of 32 patients undergoing combined endoscopic endonasal and transcranial surgery.
• Patients were categorized into simultaneous or staged groups based on the procedure timing.
• Outcomes assessed included rationale for approach selection, clinical results, resection extent, and complications.

Main Results:

• Gross-total resection was achieved in 50% of patients in both simultaneous and staged groups.
• Cerebrospinal fluid leak rates were significantly lower in the simultaneous group (4.5%) compared to the staged group (30%).
• Preoperative neurological deficits improved in a similar proportion of patients across both groups.

Conclusions:

• Combined endoscopic endonasal and transcranial approaches provide favorable results for complex skull base lesions.
• Simultaneous and staged combined strategies show comparable outcomes, except for a higher rate of cerebrospinal fluid leaks in the staged approach.
• The choice between simultaneous and staged procedures should be individualized based on lesion specifics and surgical team expertise.