Will Endoscopic Surgery Be a Messiah for Midline Skull Base?

Abstract

esions in the central skull base cavity surrounded by cranial nerves have been the most difficult to remove microL surgically because the surgeon has to retract the surrounding brain, crossing cranial nerves and perforators from the circle of Willis or basilar system. The advantage of endoscopic transsphenoidal surgerymay be accessibility, avoiding the need to cross the cranial nerves and vessels. Availability in a narrow and deep corridor such as the nasal sinus, where a straight light beam by microsurgery could not reach without a nasal retractor, may be an additional advantage. An endoscope has a wider lens than a microscope, and the blind corner is smaller compared with a microscope. If an angled lens is used, the surgical field becomes wider, as shown by Silva et al. A minimal surgical opening without a craniotomymaybe attractive for thepatient. Theminimal surgical opening has already been shown to be preferred by patients in the abdominal endoscopic approach in general surgery.