Transoral endoscopic approach to skull base lesions: A 10-year experience at a single tertiary center

Diagnosis and management of skull base lesions pose considerable challenges. Various anterior open approaches versus endoscopic techniques provide access to different regions of the skull base. As most anterior endoscopic approaches to the skull base are performed through the nasal corridor, the aim of this study was to explore the second most common route in terms of mucosal incisions and anatomical corridors, target areas, specific pathologies, surgical procedures, and outcomes. This study was a cross-sectional analysis of patients with skull base lesions who underwent the anterior transoral endoscopic approach at Imam Khomeini Hospital, Iran, between 2013 and 2023. The study included 71 patients (41.5% female; mean age: 36.8 years). Eighteen patients with skull base chordoma and six with basilar invagination underwent transoral endoscopic access via a posterior pharyngeal incision. A transoral sublabial incision with an endoscopic transmaxillary corridor was used in 33 cases with various lesions, including carcinomas, sarcomas, and benign tumors centered in the infratemporal fossa. Endoscopic transoral access to the lower parapharyngeal space, greater wing of the sphenoid, and pterygoid region was performed in nine cases using palatal, trigonal, and pilar incisions. One-third of the cases required a multiportal approach combining endonasal and transoral routes. Recurrence occurred in 14 of 38 cases of malignant tumors and in 4 of 33 cases with benign lesions. The endoscopic transoral approach can be used to access the craniovertebral junction (CVJ), infratemporal fossa, and lower parapharyngeal space. Selected lesions can be effectively managed using this approach.