Celebrating the golden anniversary of anterior skull base surgery: Reflections on the Past 50 Years and Its Historical Evolution

Abstract

With its inception nearly half a century ago through the pioneering work of Dandy, McLean, and Smith, anterior skull base (ASB) surgery is a relatively young discipline. It became a distinct entity in 1963 when Ketcham popularized the combined transcranial transfacial approach for en bloc resection of tumors of the paranasal sinuses extending into the anterior cranial fossa. However, because these procedures resulted in major morbidities and mortalities, alternative modes of treatment were sought. Since the 1970s, the introduction and promotion of the surgical endoscope by Messerklinger, Stammberger, and Kennedy, commenced the era of endoscopic sinus surgery. Thaler and colleagues described the utility of the endoscope for ASB surgery at the turn of the century. This allowed direct visualization and safer, more accurate removal of tumors. In 2001, Casiano reported the first purely endoscopic endonasal ASB resection, a novel technique that has been adopted by major skull base centers. The success of ASB surgery can be attributed to both the development of the skull base team as well as improvements in surgical techniques, instrumentation, and visualization technology. In this article, we review the historical evolution of ASB surgery as we approach the 50th anniversary since its recognition as a distinct entity.

Assessment of Mucocele Formation after Endoscopic Nasoseptal Flap Reconstruction of Skull Base Defects

“…[1][2][3][4][5][6][7][8] Although highly effective, these procedures often result in large SB defects that can lead to high-flow cerebrospinal fluid (CSF) leaks. These defects typically necessitate meticulous multilayer reconstruction to prevent postoperative failure.…”

A Journey into the Technical Evolution of Neuroendoscopy

“…CCDs are solid-state devices, usually a silicon chip that transforms optical data and light signal into electrical impulses and digital data. They are equipped with miniature cameras and can be attached to the endoscope and can be fully sterilized (36,39). The addition of CCDs improved image quality on high-resolution screens, transmission of images, and the miniaturization of the endoscopic system.…”

Minimally invasive endoscopic resection for the treatment of sinonasal malignancy: the outcomes and risk factors for recurrence

“…Endonasal endoscopic surgery, also named minimally invasive endoscopic resection (MIER), has been used to manage sinonasal malignancy (SNM) since the 1990s 1–3. Over the past 2 decades, although MIER has become an increasingly practiced procedure, the role of endoscopic surgery in the treatment of SNM remains undetermined 4,5.…”

“…Over the past 2 decades, although MIER has become an increasingly practiced procedure, the role of endoscopic surgery in the treatment of SNM remains undetermined 4,5. Clinical studies have reported that MIER offers an equivalent benefit in terms of patients’ survival compared to anterior craniofacial resection (ACFR), improves patients’ quality of life, and decreases postoperative morbidity in carefully selected patients 3,5–8. However, the late presentation of SNM and its juxtaposition to important anatomical structures such as eyes and brain pose a challenge to surgical management: what should be the proper extent of resection?…”