Endoscopic approach to the anterior skull base

Abstract

Today, endoscopic endonasal operations have become daily routine in ENT-surgery, particularly endonasal surgery in cases of chronic polyposis of the paranasal sinuses. Younger ENT surgeons become familiarized with these endonasal techniques during their training. On the other hand, the number of operative procedures on the paranasal sinuses via the possible external approaches is decreasing because a growing number of diseases can be treated by modern endonasal techniques. Modern suction-irrigation endoscopes, combined with a high performance endocamera (chip camera) provide a clear vision in the operative field. This allows the surgeon to work quite safely inside the nose and the paranasal sinuses, as well as near to the posterior part of the orbit and the frontal skull base. Working under videoendoscopic control is especially safer for the less experienced surgeon because supervision of every step of the operation is easy to achieve. Many patients with chronic polyosis of the sinuses are resistant to conservative drug treatment and depending on the amount of polyposis, are typically treated by endonasal operations, such as partial ethmoidectomy or complete sphenoethmoidectomy. However, during the last few years more conditions involving the frontal skull base or the paranasal sinuses are treated by endoscopic approaches. 1-4 We have developed a new concept for the treatment of conditions such as cerebrospinal fluid (CSF) leakage, fractures of the skull base and the orbit, etc., primarily using endoscopic minimally invasive operative techniques.