Tailored, Individually Adapted Transnasal Endoscopic Approaches to the Anterior and Central Skull Base

Endoscopic transnasal approaches offer excellent transnasal visualization and manipulation within the central skull base. However, performing wide expanded exposures, surgical trauma may increase causing subsequent rhinological morbidity among patients. In this retrospective study, we analyzed the operative results of 50 consecutive cases; which included 28 pituitary adenomas, 5 Rathke cysts, 4 clival chordomas, 4 meningiomas, 2 adenocarcinomas, 2 craniopharyngiomas, 2 esthasioneuroblastomas, 2 angiofibromas, and 1 cavernoma. These were operated in a rhinoneurosurgical-team approach. According to nasal/paranasal anatomy and to the target region, following endoscopic exposures were used: uninostril transethmoidal (n = 2); uninostril paraseptal (n = 6); uninostril transethmoidal-paraseptal (n = 29); binostril transethmoidal-paraseptal (n = 5); binostril extended transethmoidal (n = 6); combined transnasal-transcranial (n = 2). Special attention was given to surgical and sinonasal outcome. Removal of the middle turbinate and septal resection could be avoided in all cases; septum and/or turbinoplasty were performed in four cases for functional reasons. Operative revision was necessary in two cases for CSF fistula and in one case for nasal rebleeding. Rhinological follow-up revealed no postoperative nasal complications and no hyposmia. Individually adapted endoscopic transnasal approaches are able to optimize surgical exposure and minimize approach-related traumatization of the nasal cavity.