Operative Techniques in Otolaryngology-Head and Neck Surgery
Endoscopic versus open approaches to the skull base: A comprehensive literature review
Section snippets
Study selection
We performed a literature search by using the Ovid gateway of the MEDLINE database between the years of 1950 and 2010. Eligibility criteria were limited by the nature of existing literature on this topic, which consists of only case series and case reports. All publications in which the authors examined outcomes after surgery of the skull base were selected, whereas editorials, commentaries, and review articles were not because they did not include original data. To avoid duplication of
Meningiomas
A total of 75 series and 1847 patients were included, which described outcomes for tuberculum sellae and olfactory groove meningiomas. For olfactory-groove meningiomas, there were 568 patients in the open group and 19 patients in the endoscopic group. There was a significantly greater rate of GTR in the open group (92.9% vs 63.2%, P < 0.001) and a significantly greater rate of partial resection in the endoscopic group (0.4% vs 26.3%, P < 0.001; Figure 1). There was a greater rate of CSF leak in
Discussion
For tumors of the midline anterior cranial fossa, a ventral surgical approach, that is, passing through the sinuses and nasal cavity, is logical, assuming the tumors do not have significant lateral extension beyond the carotid arteries and lamina papyracea. Before the development of endonasal endoscopic cranial-base approaches, open cranial-base approaches were frequently used to reach even small midline tumors, to provide enough light from the microscope to visualize the full extent of the
Conclusions
Our systematic review supports the conclusion that the endoscopic endonasal approach may be an alternative to traditional open cranial-base surgery or transsphenoidal microscopic approaches for the treatment of certain tumors of the anterior skull base, particularly small midline tumors. For some pathologies such as tuberculum sellae meningiomas, clivalchordomas, or odontoidectomy, endonasal approaches may offer equivalent rates of total removal with significantly lower morbidity and improved
References (16)
- et al.
An endoscopic endonasal technique for resection of olfactory groove meningioma
J Clin Neurosci
(2008) - Komotar RJ, Starke RM, Raper DMS, et al: Endoscopic endonasal versus transsphenoidal microscopic and open transcranial...
- Komotar RJ, Starke RM, Raper DMS, et al: The endoscope-assisted ventral approach compared with open microscope-assisted...
- Komotar RJ, Starke RM, Raper DMS, et al: Endoscopic endonasal versus open transcranial resection of anterior midline...
- et al.
Endoscopic transnasal resection of anterior cranial fossa meningiomas
Neurosurg Focus
(2008) - et al.
Endoscopic endonasal resection of anterior cranial base meningiomas
Neurosurgery
(2008) - et al.
Endoscopic endonasal transethmoidal transcribriform transfovea ethmoidalis approach to the anterior cranial fossa and skull base
Neurosurgery
(2010) - et al.
Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery
Am J Rhinol Allergy
(2009)
Cited by (10)
Is There a Role for Craniofacial Surgery in the Treatment of Extensive or Recurrent Head and Neck Tumors Involving the Cranial Base?
2017, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :With the growing acceptance of endoscopic approaches, their complication rates have been frequently compared with those of CFS. Most endoscopic studies have reported lower complication rates ranging from 11 to 31.6%.6,9,22,31-34 The advocates of endoscopic endonasal approaches often attributed such changes in complication rates to the pros of minimally invasive techniques and maximal preservation of unrelated structures.17,20
The Unusual Presentation of a Myxoma Within the Sphenoid Sinus: Case Report and Review of the Literature
2017, World NeurosurgeryCitation Excerpt :By using a natural corridor, the technique does not leave any external scarring.33,34 The procedure may lead to less blood loss, reduced length of stay, and faster recovery.35,36 The main disadvantage of the endoscopic endonasal approach for the treatment of skull base tumors is the reduced ability to achieve marginal en bloc resections, especially for large extensive tumors.
A Simple Scoring System to Predict the Resectability of Skull Base Meningiomas via an Endoscopic Endonasal Approach
2016, World NeurosurgeryCitation Excerpt :Another limitation in the study relates to the learning curve associated with EEA.6,8,16 Our rate of gross total resection is similar to other higher volume published series, and despite the relatively small number of patients, it was not apparent that the rate of complete resection improved with time.6-8,12,16 Indeed, the rate of GTR appeared to be related mostly to patient selection, which is reflected in the results of our study.
A systematic review of published evidence on expanded endoscopic endonasal skull base surgery and the risk of postoperative seizure
2013, Journal of Clinical NeuroscienceCitation Excerpt :The advantages offered by this technique over conventional transcranial or transfacial surgery is in part related to minimal disruption of normal tissue, superior visualization at the target, and the avoidance of brain and cranial nerve retraction. Moreover, the extent of tumour resection afforded by the endoscopic ventral approaches is considered comparable to traditional microsurgical skull base series.3–5 As the clinical indications for endoscopic endonasal skull base (EESB) surgery continue to expand, few studies have defined the risk of postoperative seizures following this type of surgery.
Approaches to repairing skull base defects for the prevention of cerebrospinal fluid (CSF) leakage
2020, Challenges in Rhinology