Conventional and Powered Instrumentation for Endoscopic Skull Base Surgery

Abstract

Technology is evolved enough to treat many pathologies involving anterior skull base. These procedures require mostly, providing a surgical corridor for instruments, exposure of the important structures, removal of bone and ligation of arteries when necessary, and the reconstruction of dural and skull base defects afterward. Endoscopic imaging is the key to success. Technology is ever evolving since the invention of Hopkins rod-lens system in 1960 to better delineate the surgical corridor and anatomical details. Fine and angled instruments were designed to reach far lateral areas, as well as powered instruments and coagulation devices to adapt endoscopic working. All these developments require surgeons to adapt new skills for endoscopic skull base surgery, which has a demanding learning curve. Therefore, review of current technology of endovision systems, conventional and powered instruments, as well as image guidance systems carries importance for endonasal endoscopic skull base surgeries. After introduction of endovision systems, surgeons adapted themselves to operate through a monitor instead of directly looking through Hopkins rod-lens telescopes. Using video-monitoring endovision systems brought advantages as binocular vision, magnification, and stable body posture, which all made long-lasting endoscopic skull base surgeries possible. Different image enhancement systems have been introduced, primarily focusing on differentiating pathologic mucosa from healthy mucosa. Among them, Narrow Band Imaging® (NBI) technology by Olympus™ and Storz Professional Image Enhancement System® (Image1 S) technology by Karl Storz™ are widely used. These technologies found widespread use and research area in many disciplines of medicine, including rhinology.