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[Endoscopic and Combined Skull Base Surgery - The Experience of Shaare Zedek Medical Center]
Boaz Forer1, Jameel Ghantous1, Shaul Chanan1
1Department of Otolaryngology, Head and Neck Surgery, Shaare Zedek Medical Center, Jerusalem, The Hebrew University.
Introduction:
The anterior skull base forms the bony floor of the anterior cranial fossa and serves as a barrier between the sinuses and nasal cavity and the brain. The most common pathologies in this area include tumors (benign and malignant), inflammatory and infectious diseases, congenital anomalies, and traumatic injuries. Anterior skull base surgeries are performed as part of a multidisciplinary team effort. In the past, these surgeries were performed using open approaches, but with the advancement of endoscopic technology, most surgeries are now performed using minimally invasive techniques, improving recovery and reducing complications.
Objectives:
To provide a descriptive review of all anterior skull base surgeries performed using endoscopic or combined approaches at Shaare Zedek Medical Center from the department's establishment until the end of 2024.
Methods:
The study was based on data collection from all surgeries recorded in the database of the Shaare Zedek Medical Center.
Results:
Between the years 2017 and 2024, a total of 177 anterior skull base surgeries were performed, including 163 for primary pathologies and 14 revision surgeries. Postoperative CSF leak occurred in 5.5% of patients, and symptomatic residual tumors were observed in 3%. Most surgeries were performed using the endoscopic approach, except in cases of extensive bony deficiency or intracranial involvement, where a combined approach was used.
Conclusions:
The transition from open to endoscopic approaches has led to significant improvements in managing anterior skull base surgeries. However, in selected cases, the combined approach offers advantages by integrating open and endoscopic techniques. Multidisciplinary expertise contributes to the success of these surgeries and minimizes complications.
Discussion:
The endoscopic approach to the anterior skull base represents a breakthrough in treating complex pathologies in this region. The integration of the combined approach in complex cases enables optimal treatment while maintaining minimally invasive principles. The use of advanced techniques and multidisciplinary collaboration improves the quality of care and reduces the risk of complications.
