Comparative surgical anatomy of endoscopic and open approaches to the skull base

Abstract

Introduction: The primary goal of the research was to assess the feasibility of minimally invasive surgical approaches to the cranial base. This was accomplished by conducting endoscopic anatomical studies demonstrating innovative surgical corridors. The aim was to detail the anatomy of these hidden areas, difficult to access by traditional surgical approaches, in order to facilitate minimally invasive intervention. Endoscopic surgery minimizes the potentially severe morbidity and mortality of cranial base surgery. Most of the research that has been conducted in this area has focussed on the midline of the skull base. This research has looked at the viability of accessing the lateral regions. Methods: The anatomical studies were conducted at the Georgia Skull Base Research Laboratory located on the Georgia Regents University campus in Augusta, Georgia USA. This laboratory is equipped with endoscopy, latex injected cadavers and the necessary surgical dissection instruments. Each anatomical study incorporated appropriate endoscopic surgical technique to elaborate the specific anatomy. Photographic records were obtained, with subsequent discussion of pertinent findings. Objectively, measurements were made utilizing computed tomography. This quantified the amount of exposure in each of the surgical approaches. As each research project was completed it was submitted for publication in internationally peer-reviewed journals. Results: The endoscopic and open approaches provided access to the lateral regions of the skull base. The endoscopic approach, while more technically difficult, did provide a minimally invasive corridor. The objective measurements obtained from the computed tomographic scans verified this with less tissue removal when compared to the open approaches. The photographic evidence also demonstrated similar access using either approach. Conclusion: The endoscopic endonasal approach to lateral regions of the skull base is anatomically feasible in select cases. The morbidity associated with brain retraction from the open approaches can be avoided. Further understanding of the endoscopic potential of this region can allow for advances in endoscopic endonasal surgery and improvement in the safety and efficacy of these procedures.