The Expansive Realm of Skull Base Neuroendoscopy

Abstract

Collaboration between otolaryngologists and neurosurgeons has been a cradle of innovation in the field of skull base neurosurgery. The introduction of endoscopy, first as an adjunct to microneurosurgery and later as a gold standard procedure for certain pathologies, resulted from such an alliance. German physician Philipp Bozzini (4) is credited for the invention of the Lichtleiterin, a light conduit used in the 18th century to inspect the ear, nasopharynx, and wounds. But it was Victor Darwin Lespinasse (7) who first used it intraventricularly—in an operation to treat hydrocephalus, he used a modified cystoscope to coagulate the choroid plexus. Guiot (8) was the first neurosurgeon to use the endoscope in the endonasal transsphenoidal approach to pituitary tumor. Since then, the endoscope has become a regular feature of neurosurgery. Noted pioneers Fukushima (5), Apuzzo (1), and Bushe (3) used the endoscope to aid in microsurgical resection of tumors. The endoscopes they used were still in the developmental phases and mainly served as an adjunct to microscopes. In the following years, otolaryngologists increasingly used endoscopes for parasellar approaches. Based on these efforts, the concept of a pure endoscopic transsphenoidal approach to sella emerged, most commonly for pituitary adenoma. Neurosurgeon Jho and otolaryngologist Carrau published their experience of 45 cases of pituitary adenoma (10). Concurrently in Europe, Paolo Cappabianca and Enrico de Divitiis from Naples and Giorgio Frank and Eresto Pasquini from Bologna spearheaded the expansion of the transnasal endoscopic approach. The developments in neuronavigation, the angled lens system, and neuroimaging led to the expansion of skull base endoscopy. The concept of expanded endoscopic skull base surgery became a reality, and such previously unreachable areas as the region from the crista galli to the craniovertebral