The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: A 2014 perspective

Abstract

Background:The past two decades have been the setting for remarkable advancement in endonasal endoscopic neurosurgery. Refinements in camera definition, surgical instrumentation, navigation, and surgical technique, including the dual surgeon team, have facilitated purely endonasal endoscopic approaches to the majority of the midline skull base that were previously difficult to access through the transsphenoidal microscopic approach.Methods:This review article looks at many of the articles from 2011 to 2014 citing endonasal endoscopic surgery with regard to approaches and reconstructive techniques, pathologies treated and outcomes, and new technologies under consideration.Results:Refinements in approach and closure techniques have reduced the risk of cerebrospinal fluid leak and infection. This has allowed surgeons to more aggressively treat a variety of pathologies. Four main pathologies with outcomes after treatment were identified for discussion: pituitary adenomas, craniopharyngiomas, anterior skull base meningiomas, and chordomas. Within all four of these tumor types, articles have demonstrated the efficacy, and in certain cases, the advantages over more traditional microscope-based techniques, of the endonasal endoscopic technique.Conclusions:The endonasal endoscopic approach is a necessary tool in the modern skull base surgeon's armamentarium. Its efficacy for treatment of a wide variety of skull base pathologies has been repeatedly demonstrated. In the experienced surgeon's hands, this technique may offer the advantage of greater tumor removal with reduced overall complications over traditional craniotomies for select tumor pathologies centered near the midline skull base.

The Chance of Permanent Cure for Micro- and Macroprolactinomas, Medication or Surgery? A Systematic Review and Meta-Analysis

“…So far, surgical treatments are chosen as first-line therapies only in special conditions like pituitary tumor apoplexy, acute visual deterioration, cranial hypertension or after considering patient preference ( 14 , 15 ). Based on the fact that modern neurosurgical techniques for pituitary approaches have been remarkably developed over the last decades, especially the development of endoscopic transsphenoidal surgery, normalized PRL level and restored gonadal function following complete resection of tumor have been shown in emerging cases with infrequent severe complications ( 16 – 18 ).…”

Application of endoscopic endonasal approach in skull base surgeries: summary of 1886 cases in a single center for 10 consecutive years

“…Endoscopic endonasal skull base surgery has undergone rapid technological development, and its scope of application has also gradually expanded. Endoscopic endonasal skull base surgery combined with microsurgical skull surgery constitutes the foundation of modern minimally invasive skull base surgery [ 2 – 4 ]. The surgical quality and prognosis of skull base surgery have greatly improved through extensive application of neuroendoscopy combined with electrophysiological monitoring, neuro-navigation, ultrasound Doppler, high-speed drill, laser, ultra-suction, support arms, and other technologies and equipment.…”

Endoscopic endonasal approaches to the skull base tumors: minimally-invasive approach with achievement of radicality. Our experience

“…Tumors with intra-extra cranial extension or with pure external extension to the skull base surface are always challenging for surgeon. Complicated anatomy and difficult access to critical structures, necessity of removal of massive bone structures could eventually make surgery difficult [1,2]. Complete resection is challenging for invasive tumors using standard microsurgical route [2].…”

“…Complicated anatomy and difficult access to critical structures, necessity of removal of massive bone structures could eventually make surgery difficult [1,2]. Complete resection is challenging for invasive tumors using standard microsurgical route [2]. The first applications of the endoscope in transsphenoidal surgery were described by Apuzzo et al [3].…”