Endoscopic Endonasal Transsphenoidal Skull Base Surgery

Abstract

Endoscopic skull base surgery has significantly developed than the past years because of the improved understanding of endonasal endoscopic skull base anatomy, developed endoscopic techniques and the changes of endoscopic technologies. From the management of inflammatory pathologies, we have learned to manage skull base lesions. Current anatomical knowledge with computer aided surgery has enabled surgeons to remove large lesions in the paranasal sinuses extending beyond the boundaries of the sinuses themselves. And so, the management of benign diseases with endoscope is nowadays well accepted whilst the role of endoscopic techniques in sinonasal malignancies is still under investigation. Nowadays, it is possible to tackle different pathologies placed not only in the ventral skull base, but also extended laterally (infratemporal fossa and petrous apex) and even, in really selected cases, within the orbit. At the moment, the improvement in surgical techniques has rendered endoscopic procedures capable of managing complex pathologies, according the same surgical principles of the open approaches. From now on, frameless neuronavigation, modular approaches, intraoperative imaging systems and robotic surgery are and will be an increasingly important part of endonasal surgery, and they will be overtaken by further evolution.