Endoscopic techniques in skull base surgery

Abstract

Since its inception, neurosurgery has benefited from close collaborations with other specialties. Each succeeding decade has been marked with key advances based on these collaborations. The original collaboration with otolaryngology led to the refinement of microsurgical techniques, and the collaboration between neurosurgery and radiation oncology evolved into the current concepts of stereotactic radiosurgery. In the 1990s, the interaction between neurosurgery and interventional radiology created the discipline of endovascular neurosurgery, and the intense collaboration between otolaryngology, plastic surgery, and neurosurgery originated the field of skull base surgery. Each of these advances has been characterized by crosspollination that allowed the integration of parallel technological developments as they occurred within each field. Physicians using these new treatment algorithms strove to make them the standard of care based on improved clinical outcomes. In each instance, a demonstration of feasibility and an initial learning curve was followed by a period of validation and the popularization of those reproducible elements that resulted in improved outcomes. These events eventually resulted in new treatment paradigms that incorporated the original and the emerging technologies and procedures. Over the past several years, similar collaborations and cross-pollination have spearheaded the concept of minimally invasive surgery along the entire neuraxis, with endoscopy being used as the primary visualization tool