Could transcranial endoscopy represent an alternative to craniotomy in skull base surgery?

Craniofacial malformations and upper third facial tumor surgical management is currently performed by skull base osteotomies to allow skeleton mobilization or tumor removal. Craniotomies and retraction of frontal lobes allow wide exposure of anterior skull base. In the last decades, in keeping with the trend to perform less invasive surgical approaches, several authors reported endoscopic approaches for selected cases of skull base surgery, such as closure of cerebrospinal fluid leaks and transethmoidal and trans-sphenoidal approaches for pituitary surgery. Recent experience with transnasal endoscopic procedures improved both techniques and outcomes and became more common. The authors present a cadaver study of combined transfacial transcranial endoscopic approach to skull base. Such an approach used with minimally invasive surgery principles could represent, in selected cases (both for neoplastic lesions and malformations), an alternative to traditional anterior cranial fossa surgical approaches by wide craniotomies.