Limitations Of Endoscopic Ventral Skull Base Surgery: A Series Of Eleven Challenging Cases And Review Of Literature-A Retrospective Study

Abstract

Background: The surgical outcome in different pathologies of skull base has significantly improved with endoscopic endonasal approaches. As the grass is not always green on all side, there remains some limitations to endoscopic skull base surgery. In our paper we will discuss preoperative imaging of common pathologies amenable to endoscopic treatment, instrumentations, and limitations of skull base surgery. Retrospective analysis of the prospectively maintained records of the patients operated for skull base tumor was done between January 2016-Febuary 2019. Patients having skull base tumors irrespective of age, sex. Tumors found inoperable endoscopically after a panel discussion of Neurosurgeon, Neuro-otologist and Neuro-anesthesiologist. Patients who underwent endonasal endoscopic surgical excision at our centre. Results (Case description) Out of 383 skull base pathology patients operated through endoscopic endonasal approach between January 2016- February 2019, eleven(2.87%) patients of skull base tumours who were found inoperable endoscopically were included in our series. The limitations of endoscopic endonasal approach is shown in Table 1. We hereby discuss the technical nuances and details of each cases, in order to highlight the limitation of endo-nasal corridor Conclusion Although endoscopic trans-nasal surgery is emerging as popular alternative to microscopic surgery and replacing it fast, one should not become tool dependent. A lot of conditions still required microsurgical expertize and demand proper training and anatomical considerations. Every case must be approached on individualized basis. A proper pre-operative evaluation is key to success. Keywords: Limitations, endoscopic, ventral, skull base