Extended Endoscopic Approach to the Anterior and Central Skull Base: Is It Safe in a Low-Volume Center?

• Main Authors: Lanisnik, B., Ravnik, J.
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0032-1313992

Aim: Currently there are no reliable data on number of endoscopic skull base procedures performed to achieve proficiency. In the recent years a technology became available that helps and facilitates the learning curve process. We describe results of the EEA in a low-volume center. Methods: All procedures were performed using four-handed endoscopic surgery. The ENT member is responsible for approach and reconstruction and the neurosurgeon is responsible for tumor removal. Proficiency was achieved through advanced revisional FESS, orbit decompression, optic nerve decompression, and duraplasty of the meningoencephalocele. The pivotal competency is, in our opinion, reconstruction of the dura (duraplasty). The neurosurgeon was trained in four-hand surgery by participating during revisional FESS. In all cases, we use image guidance to facilitate the decision-making process. Results: Thirty-nine patients (22 men, 16 women) were operated on during the time period from 2005 to 2011: 5 adenocarcinomas, 3 melanomas, 1 SNUC, 2 esthesioneuroblastomas, 10 pituitary macroadenomas, 4 meningiomas, 1 congenital prepontine cyst, and 1 neurinoma of the pterygopalatine fossa. Three optic nerve decompressions and 9 CSF leaks were also treated by this approach. All patients recovered well after surgery. Among 14 patients with visual disturbances, 10 improved visual function, it remained the same in 3, and it deteriorated in 1 patient. One case of CSF leak needed revision. Conclusion: EEA is safe even in low-volume centers with the implementation of a training model where proficiency is achieved through endonasal procedures for pathology, which are more frequent.