3D Endoscopic Endonasal Approach in Skull Base Surgery: Experience on 87 Consecutive Patients

Abstract

Objectives: Assess advantages and disadvantages of 3-dimensional endoscopy in the transnasal approach to sellar region, posterior skull base, and cervical junction. Methods: Between January 2012 and December 2013, 87 patients were consecutively treated at the Neurosurgery Division of the University of Turin for sellar, skull base, and cervical junction pathologies. All procedures were performed by the same team (2 ENT surgeons and 2 neurosurgeons) using a 3-dimensional (3D) stereoendoscope (VSII system, Visionsense Ltd, Petach Tikva, Israel). After each procedure each surgeon was asked to fill out a questionnaire (based on visual analogue scales) designed to assess comfort and learning curve. Results: Seventy patients were treated for pituitary macroadenomas, 10 for chordomas, 6 for a malformation of the cervical junction, and 1 for a chondrosarcoma of the odontoid process of C2. A cerebrospinal fluid (CSF) leak was observed in 6 out of 70 patients, 1 out of 10 patients, and 0 out of 7 patients, respectively; 5 out of 7 CSF leaks were intraoperatively solved and 2 out of 7 required revision surgery. No vascular complications were recorded. Median global comfort score (sensation of strain + dizziness + system ergonomics scores), recorded at the end of the first and second procedure, was 9.1 and 9.6, respectively; after the third procedure it reached 10. The learning curve score reached the maximum level of 9.5 after the eighth procedure. Conclusions: 3D stereoscopic vision system is comfortable for the surgeons allowing them to have a better visualization of anatomic structures and landmarks; it is easy to use and after only a few procedures surgeon skills reach high levels.