Clinical considerations for open versus endoscopic approaches in skull base surgery

Abstract

Purpose of review We aim to distill the current body of evidence to consider when selecting an endoscopic versus open approach to address cranial base disease. We evaluate the evolution of modern surgical techniques and their respective limitations. Recent findings Greater understanding of the role of tumor biology in relation to patient outcomes has led to increasingly sophisticated treatment algorithms. This combined with further development of advanced instrumentation and technique has led to the adoption of new surgical corridors previously unapproachable via traditional surgery. Summary Endoscopic and open craniofacial approaches both remain important surgical techniques in the management of cranial base tumors. The modern skull base surgeon may employ a combination of approaches to optimize tumor extirpation while preserving functional outcomes. Patient history, anatomic tumor extent, histology, and functional goals should be considered thoroughly when planning any surgical intervention.

Pterional Craniotomy With Anterior Clinoidectomy for the Resection of a Sphenoid Ridge Meningioma: A Case Report and Two-Dimensional Operative Video

“…Radical resection provides patients suffering from meningiomas with the best prognosis and long-term disease control [ 12 , 13 ]. Sphenoid ridge meningiomas are characterized by deep location, complex structures, and narrow surgical space, leading to a high risk of damaging nerves, blood vessels, and brainstem as well as possibly causing postoperative paralysis, so that completely removing it could be challenging [ 8 , 14 ].…”

Neurosurgery for the rhinologist

“…These sinuses directly connect the nasal cavity and several nearby neurovascular structures within the skull base. Historically, gaining access to pathologies located in the ventral skull base required invasive craniofacial procedures, which could lead to high morbidity and poor outcomes [1,2,3 ▪ ,4]. However, over the years, there has been a transition towards less invasive approaches, aiming to decrease surgical injuries caused by invasive transcranial approaches, optimizing the postoperative course, and clinical outcomes for the patient.…”

The Current State of Visualization Techniques in Endoscopic Skull Base Surgery

“…Starting only with the naked eye and candlelight, neurosurgery progressed through improving forms of visualization and illumination to surgical loupes and headlights, to microscopes, endoscopes, and exoscopes. Improved magnification and illumination have allowed neurosurgeons to move from very large open craniotomy approaches to smaller, more tailored open and keyhole approaches, and to endonasal approaches, which use the natural nasal cavity to access the skull base [ 1 ].…”