Endoscopic endonasal skull base approach

Recent advances in endoscopic technologies have had a major impact on the management of skull base lesions. Endoscopic endonasal skull base surgery (EESS) provides direct access to ventral skull base lesions with the least manipulation of important neural structures. By EESS, the traditional boundaries of transsphenoidal surgery can be extended to the whole ventral skull base including the anterior skull base, clivus and cavernous sinus. Two key principles of endonasal skull base surgery are bimanual dissection under direct visualization and team surgery in collaboration with otolaryngologists. Benefits of the surgical team approach include improved visualization, manipulation, and problem-solving, leading to better surgical results. Skull base reconstruction is one of the most important procedures in endonasal skull base surgery. The introduction of the septal mucosal flap for dural reconstruction has decreased the incidence of postoperative cerebrospinal fluid leaks. Although further advances in surgical technology including instruments adapted for intranasal use and materials for dural reconstruction are needed, EESS is a promising minimally invasive alternative for ventral skull base lesions.