Indications and Limitations of Endoscopic Skull Base Surgery: Single Institute Experience

Objective: The traditional boundaries of the transsphenoidal approach can be expanded to include the region from the cribriform plate to the foramen magnum in the anteroposterior plane. The introduction of endoscopy with its improved illumination and wider field of view to transsphenoidal surgery has added significant further potential for the resection of a variety of cranial base lesions. We review our experience with the expanded endoscopic endonasal approach in a series of 58 patients.

Subjects: From 2009 to 2012, the expanded endoscopic endonasal approach was performed in 58 patients.

Methods: Different skull base pathologies were enrolled from craniopharyngiomas, esthesioneuroblastomas, suprasellar Rathke pouch cysts, giant pituitary adenomas, angiofibromas, meningiomas, paranasal malignancies, encephaloceles, and gliomas. This study specifically focuses on the surgical indications, results, complications, and the limitations.

Results: Gross total tumor removal as assessed by postoperative magnetic resonance imaging was possible in 44 patients (75.8%). There were no permanent neurological complications except for increased visual disturbance in one patient and transient left VI palsy in another patient. Other complications included cerebrospinal fluid fistulae in five patients (8.6%) and meningitis in one (1.7%). There was no operative mortality. Large lesions, significant lateral extension, encasement of neurovascular structures, and brain invasion in malignant lesions are considered among the contraindications for this technique.

Conclusion: The expanded endoscopic endonasal approach is a promising minimally invasive alternative to open transcranial approaches for selective lesions of the midline anterior skull base. This approach should be in the armamentarium of skull base surgeons.