ICAR: endoscopic skull‐base surgery

Abstract

Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

Management of Cerebrospinal Fluid Rhinorrhea in the Sphenoid Sinus Lateral Recess Through an Endoscopic Endonasal Transpterygoid Approach With Obliteration of the Lateral Recess

“…Despite the multiple options for skull base reconstruction, there is no consensus within the literature regarding the best treatment option. 21 In this study, multilayer reconstruction of skull base defects and obliteration of the SSLR with abdominal subcutaneous fat were adopted. All the patients were successfully treated on the first attempt, and the overall success rate was 100%.…”

Validation of Simultaneous Endoscopic Sinus Surgery and Transsphenoidal Surgery in Patients with Chronic Rhinosinusitis and Pituitary Tumors

“…11) While visual field restriction during surgery was resolved by the introduction of surgical endoscopy and navigation systems, the risk of cranial complications has remained a challenge for surgeons. 12) Currently, the endonasal endoscopic approach is frequently used to treat pituitary lesions; it is gradually becoming the pre- ferred approach for most pituitary tumors. 8) The incidence of meningitis due to TS surgery has been reported to range from 0.4% to 9%.…”

The expanded endonasal approach in pediatric skull base surgery: A review

“…In the past, surgical treatment of these lesions was primarily through open or external approaches . However, with advances in endoscopic technology and advances in expanded endonasal approaches (EEAs) in adults, these techniques have been increasingly applied to the pediatric population . Multiple case series of EEA in pediatric patients have been reported, demonstrating that endoscopic endonasal techniques are an option in appropriate pediatric cases .…”