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

Selection of the safest and most effective surgical approach for complex skull base lesions is a matter of great relevance and significant controversy. A combination of endoscopic endonasal and transcranial approaches for complex skull base pathology is underinvestigated. We aim to analyze our experience with combination of endonasal endoscopic and transcranial approaches, either simultaneously or as staged procedures.

Thirty-two patients underwent a combined strategy. Patients were divided into simultaneous or staged group. Lesions were classified according to pathology and skull base compartments. Primary endpoints were rationale for selection of approaches, clinical outcomes, extent of resection, and postoperative complications in both groups.

Twenty-two patients underwent a simultaneous strategy, and 10 a staged approach. Gross-total resection was achieved in 11 patients (50%) in the simultaneous group and in 5 patients (50%) in the staged group. Cerebrospinal fluid leak occurred in 1 out of 22 cases (4.5%) in the simultaneous group, and in 3 out of 10 cases (30%) in the staged group ( P = .043). Preoperative neurological deficits improved in 5 out of 9 patients in the simultaneous group and 5 out of 9 in the staged group.

Our study showed that, except for cerebrospinal fluid leak rates, there were no main significant differences between performing both approaches simultaneously or staged. Selection of the strategy depends on the characteristics of the lesion and surgical team. When complex lesions expand from the central skull base into anterior, middle, or posterior regions, a combination strategy can provide favorable results.