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OTORINOLARINGOLOGIA

A Journal on Otorhinolaryngology, Head and Neck Surgery,
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Otorinolaringologia 2007 December;57(4):189-200

language: English

Endoscopic endonasal surgery of the skull base: the expanded approaches

Prevedello D. M. 1, Kassam A. B. 1,2, Snyderman C. 1,2, Gardner P. 1, Mintz A. 1, Carrau R. 1,2

1 Department of Neurosurgery University of Pittsburgh School of Medicine Pittsburgh, PA, USA
2 Department of Otolaryngology University of Pittsburgh School of Medicine Pittsburgh, PA, USA


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Endoscopic endonasal approach (EEA) for skull base surgery (SBS) represents a significant modification of the current practice. There has been considerable discussion regarding the experience and methods needed to develop the required skills. The authors reviewed the experience at the University of Pittsburgh with EEAs for 700 patients from 1998 to January 2007. Modular approaches to multiple pathologies of the skull base were designed totally based on inherent anatomy. Stages of training were established based on the level of technical difficulty and potential risk of vascular and neural injury. Five levels were defined in an incremental manner. Practice standardization with modular, incremental training is expected to facilitate the acquisition of knowledge to safely master EEAs for SBS in an organized manner. The authors suggest adherence to the systematic acquisition of endoscopic skills, to work as an integrated team of surgeons and to have a thorough perspective of conventional SBS and endoscopic surgery. Therefore, the choice of approach must be a specific function of the anatomy and pathology rather than the surgeon’s bias or lack of experience with alternative approaches.

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