Pornthep Kasemsiri1, Ricardo L Carrau2, Leo F S Ditzel Filho3, Daniel M Prevedello3, Bradley A Otto1, Matthew Old1, Danielle de Lara3, Amin B Kassam4. 1. Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA. 2. Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA. Electronic address: ricardo.carrau@osumc.edu. 3. Department of Neurological Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA. 4. Department of Neurological Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: The anatomy of the skull base is extremely complex with an abundance of critical neurovascular bundles and their corresponding foramina as well as the insertions and origins of multiple masticatory and craniocervical muscles. These anatomic intricacies increase the difficulty of surgery within this area. METHODS: Advantages and disadvantages of endoscopic endonasal approaches (EEAs) based on the authors' sequential learning and experience are described. RESULTS: EEAs offer the advantages of using preexistent air spaces that enable accessing various areas of the skull base, while avoiding external incisions or scars and obviating the need for the translocation of the maxillofacial skeleton. In addition, EEAs are well suited to preserve neurologic, visual, and masticatory functions as well as cosmesis. However, the sinonasal corridor must be expanded and optimized to access the skull base adequately, facilitate the reconstruction of the surgical defect, avoid sinonasal complications, and minimize sequelae. Important considerations can limit or indicate the approach, such as the nature of the pathology, including location, diagnosis, and vascularity; patient characteristics, including age and medical comorbidities; surgeon attributes, including training, experience, and expertise; the resultant need to reconstruct large skull base defects and feasible alternatives to do so; and institutional resources, including adjunctive services, an intensive care unit, and operating room equipment. CONCLUSIONS: EEAs are important techniques in contemporary skull base surgery. Understanding the indications for and limitations of these approaches help to maximize outcomes.
BACKGROUND: The anatomy of the skull base is extremely complex with an abundance of critical neurovascular bundles and their corresponding foramina as well as the insertions and origins of multiple masticatory and craniocervical muscles. These anatomic intricacies increase the difficulty of surgery within this area. METHODS: Advantages and disadvantages of endoscopic endonasal approaches (EEAs) based on the authors' sequential learning and experience are described. RESULTS: EEAs offer the advantages of using preexistent air spaces that enable accessing various areas of the skull base, while avoiding external incisions or scars and obviating the need for the translocation of the maxillofacial skeleton. In addition, EEAs are well suited to preserve neurologic, visual, and masticatory functions as well as cosmesis. However, the sinonasal corridor must be expanded and optimized to access the skull base adequately, facilitate the reconstruction of the surgical defect, avoid sinonasal complications, and minimize sequelae. Important considerations can limit or indicate the approach, such as the nature of the pathology, including location, diagnosis, and vascularity; patient characteristics, including age and medical comorbidities; surgeon attributes, including training, experience, and expertise; the resultant need to reconstruct large skull base defects and feasible alternatives to do so; and institutional resources, including adjunctive services, an intensive care unit, and operating room equipment. CONCLUSIONS: EEAs are important techniques in contemporary skull base surgery. Understanding the indications for and limitations of these approaches help to maximize outcomes.
Authors: Ali Karadag; Pinar Gokdogan Kirgiz; Baran Bozkurt; Baris Kucukyuruk; Karim ReFaey; Erik H Middlebrooks; Mehmet Senoglu; Necmettin Tanriover Journal: Acta Neurochir (Wien) Date: 2021-04-13 Impact factor: 2.216
Authors: Aldo Eguiluz-Melendez; Sergio Torres-Bayona; María Belen Vega; Vanessa Hernández-Hernández; Erik W Wang; Carl H Snyderman; Paul A Gardner Journal: J Neurol Surg B Skull Base Date: 2021-02-22
Authors: Sarah Bin Abdulqader; Ziyad Al-Ajlan; Abdulrahman Albakr; Wisam Issawi; Mohammed Al-Bar; Pablo F Recinos; Saad Alsaleh; Abdulrazag Ajlan Journal: Childs Nerv Syst Date: 2018-10-18 Impact factor: 1.475