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
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.
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.
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 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 is performed to decompress the cervico-medullary junction.
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.
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
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 like cholesterol cyst or granuloma of petrous apex can be cleared by endoscopic trans-nasal corridor