Endoscopic Techniques in Anterior Skull Base Surgery: A Beginner’s Guide for ENT Surgeons

Overview:

The advancement of endoscopic techniques has revolutionized skull base surgery. Endoscopic techniques were initially applied in pituitary surgeries and subsequently expanded to other areas. A broad variety of conditions can now be treated with endoscopic skull base surgery.

Why Endoscopic Approach?

The primary benefit of the endoscopic endonasal technique is that it allows direct anatomical access to numerous intracranial and paranasal sinus lesions, eliminating the complications associated with skin incisions, facial bone flaps, or craniotomies, and brain retraction, which are unavoidable with traditional neurosurgical cuts, leading to reduced illness and death rates and, indirectly, shorter hospital stays and lower management expenses.

The endoscopic endonasal technique permit entry to the ventral skull base, ranging from the crista galli and cribriform plate to the foramen magnum. Depending on the condition and severity, a unilateral or bilateral technique may be implemented.

The endoscopic technique minimizes the requirement for large cuts, thus preventing noticeable scars, decreasing brain retraction, and lowering postoperative pain. The procedure's minimally invasive characteristics frequently result in quicker recovery and reduced hospital admissions.

Favourable results rely on careful restoration of skull base defects to avoid cerebrospinal fluid leaks and infections. Reconstruction is an essential phase, necessitating understanding of vascularized flap choices and techniques for multilayer closure

Key Steps and Techniques for Beginners

Exposure and Access

The choice of approach is based on the position of the lesion: transcribriform, transplanum, transtuberculum, and transsphenoidal pathways. The learning curve for beginners should involve advancing from simple to complex lesions.

Tumor / Lesion Resection

Utilizing straight or angled endoscopes, microinstruments, and navigation, continue to excise pathology in a systematic manner. Numerous skull base procedures now employ a piecemeal resection approach instead of en bloc excision. Caution is essential when lesions are near vital structures like optic nerves, internal carotid arteries, and cranial nerves.

Reconstruction

In open skull base surgery, vascularized flaps serve as reliable reconstructive options. The initial option is the septal mucosal flap, which is derived posteriorly from the posterior septal artery. This reconstructive approach is now the primary method for endoscopic skull base reconstruction and has significantly enhanced CSF leak rates to those of open techniques.

Postoperative care and follow-up

The healthcare team needs to observe the patient’s recovery, address any issues that occur, and support their rehabilitation through regular follow-up appointments. Patients are required to come back every two weeks for an endoscopic examination of the nasal cavity to observe the healing progress. In some cases, a second drain is placed in the spine to aid in nasal recovery and prevent CSF leaks.

Stay Ahead with GHA

Endoscopic skull base surgery continues to advance with evolving techniques and expanding applications. At Global Healthcare Academy (GHA), ENT surgeons can stay at the forefront of these innovations through specialized hands-on workshops in Rhinology and Anterior Skull Base Surgery.

Join GHA to master the latest endoscopic methods, refine your surgical precision, and elevate your expertise under the mentorship of leading specialists.