REVIEW  THE LIMITS OF ENDOSCOPIC ENDONASAL APPROACHES 

Journal of Neurosurgical Sciences 2018 June;62(3):287-96

DOI: 10.23736/S0390-5616.18.04348-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Limitations of the endoscopic endonasal transcribriform approach

Neil MAJMUNDAR ¹, Naveed H. KAMAL ¹, Renuka K. REDDY ², Jean A. ELOY ^{1, 2, 3, 4}, James K. LIU ^{1, 2, 3} ✉

¹ Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; ² Department of Otolaryngology, Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; ³ Center for Skull Base and Pituitary Surgery, Rutgers Neurological Institute of New Jersey, Newark, NJ, USA; ⁴ Department of Ophthalmology and Visual Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA

The endoscopic endonasal transcribriform approach (EETA) has become a useful strategy in the treatment of various anterior skull base pathologies, including meningoencephaloceles, olfactory groove meningiomas, schwannomas, esthesioneuroblastomas, and other sinonasal malignancies. However, not all pathologies are optimally treated through this approach due to tumor size, extent of the lesion, vascular involvement, and the presence of intact olfaction. One must be prepared to use a transcranial approach if the EETA is not favorable. In some patients, a combined approach (transcranial-EETA) may be needed in appropriate cases. Therefore, patient selection is paramount for achieving a successful result with avoidance of complications. For certain tumors, the limitations of the EETA may result in lower rates of gross-total resection, higher rates of cerebrospinal fluid leakage, postoperative impairment of olfaction, and higher complication rates. In this paper, we discuss the limitations of the EETA when considering approach selection to treat anterior skull base lesions.

KEY WORDS: Endoscopy - Skull base - Anterior cranial fossa - Meningioma - Maxillary sinus neoplasms