Access to Lesions of the Cribriform via an Expanded Endonasal Approach: A Clinical and Anatomic Review

Introduction: Over the past 10 years, the University of Pittsburgh has performed more than 1000 endoscopic endonasal approaches to the skull base. Traditionally the cribriform region has been accessed via a variety of standard transcranial approaches. As our understanding of endoscopic anatomy has increased, and technology and techniques have improved, the endoscopic endonasal approach has also become an option for access to this region.

Methods: We reviewed the anatomic and clinical considerations associated with an endoscopic transcribriform approach.

Results: We performed a purely endoscopic endonasal approach in more than 1000 patients from 1998 to 2008. The most common pathologies have been traumatic (CSF leaks), malignant (esthesioneuroblastomas), and benign (meningiomas) lesions. We had a total complication rate of 12.5%(4.4% neurological and 8% non-neurological). No patient sustained permanent neurological disability; however, 1 patient died due to multiorgan system failure. Using the nasoseptal flap, we have also developed a way to reconstruct the associated skull base defects.

Conclusion: While a number of open skull base approaches have been developed, the endoscopic endonasal approach to this region is yet another option that can be used safely to treat a variety of benign and malignant lesions with low morbidity.