Endoscopic skull base surgery involves removal of selected tumors at the base of the brain via a trans-nasal route. The field has been rapidly expanding to include newer lesions. The advantage of the endoscopic trans-nasal corridor is better visualization of deeper structures proximal to the brain which are otherwise difficult to visualize, without any external incisions and shortened hospital stay.

Lesions that can be removed via the transnasal corridor include

Pituitary adenomas
Various pituitary (non functioning or functioning) adenomas, microadenomas or macroadenomas are excised via a nasal route. Pituitary adenomas cause visual deterioration, visual field loss and headaches. Secreting adenomas cause various hormonal disturbances including acromegaly (excessive growth), amenorrhoea, difficulties in conceiving children and various other problems.

Tuberculum sellae or planum meningiomas
Meningiomas that arise from these areas can be removed via the trans-nasal corridor. A few of them would require open approaches depending on their spread.

Craniopharyngioma
It is a tumor that arises from pituitary embryonic tissue. It presents most commonly in children but can also present later in life. It presents most often with visual disturbances, headaches, excessive urination or thirst or menstrual disturbances.

Clival Chordomas
Clival chordomas arise from the clivus below the region of the pituitary. They most often cause lateral rectus palsy which essentially presents as inability to move the eye laterally on the involved side.

Odontoidectomy
Odontoidectomy is performed to decompress the cervico-medullary junction.

Esthesioneuroblastomas
Esthesioneuroblastomas as also a variety of benign or malignant lesions can be removed endoscopically. However, a rational view is to be taken when endoscopic surgery is not possible and where external surgery could be more beneficial.

Juvenile nasopharyngeal angiofibromas
It is a benign tumor but can grow aggressively at the back of the nasal cavity and spread in various compartments. Most tumors, however extensive are removed endoscopically. These tumors are found most commonly in adolescent males. Subjects present with nasal bleeding, obstruction of nasal cavity and sometimes distorted nasal features

Inverted papillomas
Unilateral nasal obstruction is considered the most common presenting symptom of patients with inverted papilloma. Other symptoms may include epistaxis, nasal discharge, epiphora, and facial pain. Although a benign condition, it is considered as pre-cancerous and hence a wide excision of the lesion is desired.

Lesions of petrous apex
Lesions like cholesterol cyst or granuloma of petrous apex can be cleared by endoscopic trans-nasal corridor

Meningocoeles, encephalocoeles and cerebrospinal fluid leak

Disclaimer: All the information given above is for basic understanding of the common man. The lesion, the approach and treatment modality is based on a variety of factors that need to be understood in detail. We bear no responsibility for wrong understanding or misuse of the above information.