Combined Use of the Endoscope and Microscope in Anterior Skull Base Tumor Surgery

Abstract

Purpose: Tumors of the anterior skull base are an interdisciplinary challenge. Especially meningiomas and chordomas frequently destroy the osseus skull base and involve the sinus region. Different transfacial and transcranial approaches were recommended to manage these lesions. The aim of our study was to evaluate the advantage of combined use of endoscopic and microscopic techniques in the anterior skull base surgery. Method: Within the last 5 years, 16 anterior skull base tumors were treated in an interdisciplinary approach. Individual surgical strategies were performed depending on histology, location, size, and prognosis of the tumors. In 6 cases endoscopic and microscopic techniques were combined. Results: Both methods demonstrate advantages and disadvantages in the management of tumors of the anterior skull base. Whereas the microscopic view into sinuses is limited, the use of the endoscope allows tumor removal behind bony edges. So the use of the endoscope can make unnecessary an additional transfacial approach in special cases of transbasal tumors. Due to the stereoscopic view, the microscope can be recommended in all cases of micropreparation of nerval structures and in cases of complications like bleeding. Conclusion: In the surgery of the anterior skull base both microscopic and endoscopic techniques are suitable. Every instrument has advantages and limitations. The combination of these techniques allows a safer and less invasive tumor resection in special cases.