Expanded Endoscopic Endonasal Approach in the Management of Anterior Skull Base Malignancies: Experience from a...

Malignancies involving the anterior skull base have been managed with open craniofacial resections for many decades and this is still a valid approach in the endoscopic era, particularly in selected patients with significant facio-maxillary structural involvement and lateral extensions of the tumor. Expanded endoscopic endonasal (EEEA) approaches, in comparison, are of the recent development in the management of anterior skull base malignancy that promises to reduce the morbidity of open craniofacial resection without compromising the principles of oncological resection and long-term survival outcomes. We aimed to study the ease of use, challenges, and outcomes of expanded endoscopic endonasal approaches in our patient cohort. A retrospective study was undertaken with prospectively collected data in 90 patients who underwent surgical management for anterior skull base malignancies from January 2012 to December 2020. These patients with varied histological features were treated with one of the three surgical approaches, expanded endoscopic endonasal approach, combined endoscopic-open approach, or open craniofacial resection. Most patients received postoperative adjuvant treatment and are on follow-up. Expanded endoscopic endonasal approach has become the approach of choice increasingly over the decade; its use has helped reduce morbidity and achieve results comparable with the existing standards reported in literature. Expanded endoscopic endonasal approach is an excellent technique in managing anterior skull base malignancies. This approach, when employed alone or in combination with the open approach, has limited the need for large open craniofacial resection, thus avoiding the open approach's morbidity in most patients.