Wednesday, August 25, 2010

Avoiding pitfalls in endoscopic skull base surgery


The advantages of endoscopic approach to skull base are many. They include:

  1. It is the most direct route to anterior skull base. This approach provides access to the following areas Sella, Cribriform plate, Planum sphenoidale, suprasellar cistern, Clivus, Pterygopalatine fossa and adjacent parasellar areas.
  2. In this approach there is decreased retraction of brain and cranial nerves when compared to that of conventional neurosurgical apporaches.
  3. Endoscope offers excellent visualization of the tumor and the surrounding neurovascular structures
  4. Post operative recovery time is short when compared to that of conventional neurosurgical approaches
As with any other procedure this method also has its flip side, which includes a steep learning curve, and need to collaborate with neurosurgeon. A cohesive collaboration with neurosurgeon is a must for successful endoscopic skull base surgical procedures.The complicated anatomy of skull base has managed to bridge these two specialities. In a nut shell an otolaryngologist navigates the pathway to the intracranial lesion while the neurosurgeon removes the tumor.

Dangers of endoscopic skull base surgery:

Since the skull base has many vital structures it should be performed with the highest degree of deligence and skill. The potential complications of any endoscopic skull base surgery include:

  1. CSF rhinorrhoea
  2. Injury to great vessels (internal carotid artery and its branches inside the skull)
  3. Injury to optic nerve
  4. Injury to other cranial nerves
  5. Bleeding from cavernous sinus
  6. Meningitis

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