Early Experience with Endoscopic Endonasal Techniques for Skull Base Pathologies at a Referral Center in Colombia: Multidisciplinary Team Approach Implementation

Background The development of skull base surgery can be roughly divided into two eras, those of open and endoscopic skull base surgery; in our practice, the open surgery showed the advantage to improve the opportunities in minimal invasive surgery. Our practice, which is done in a state center of reference in oncological pathology were the majority of patients coming from all regions of the country with extensive tumor pathology. We want to show the early experience with endoscopic endonasal techniques based on the well-known recommendations of the large groups of endonasal endoscopic surgery. As has been said endoscopic endonasal surgery is predominantly between the collaboration of neurosurgeons and rhinologic surgeons; differences in training are associated with distinct knowledge and skill sets, as well as oncological philosophy. The normalization of training and the acquisition of surgical skills for endonasal skull base surgery have been widely described for more than 10 to 15 years. Our objective is to be able to implant the model multidisciplinary team of skull base to the reality of Latin America and Colombia and at the same time to report cases managed with endonasal endonasal surgery.

Objectives To report our experience applying the recommendations of creation, training, and implementation of a multidisciplinary skull base team. To implement protocols for the management of each one of the pathologies in our institution following in the same way the recommendations of acquisition of surgical skills. Through the report of the experience of the group to be able to link other disciplines (intensive care, radiotherapy, endocrinology…) required to improve and to be able to resemble the results to the reports of the great world centers.

Methods Consolidating a group of patients (n = 32) were all diagnosed with pathologies of the skull base, excluding the requirement of combined open approaches, in a period of ∼18 months between 2015 and 2017. The following variables were taken into account: symptoms, intraoperative findings, days of hospitalization, histopathology, and initial results at 3 and 6 months.

Results Between 2015 and 2017, there were 32 patients with oncologic disease in skull base that were taken to endoscopic endonasal approach. The main diagnosis was pituitary macroadenoma, mostly functioning (ethmoidal carcinomas, chondrosarcomas, osteoid fibroma, craniopharyngioma, chordomas among others). The mean days of postoperatory hospitalization were 10 days. Also, it was described systematic protocol to follow by the multidisciplinary team to get better results.

Conclusion The conformation of a multidisciplinary skull base team is very important to improve the results of patients with cranial base cancer. It is clear that other disciplines must be incorporated into the skull base team; follow the recommendations of training and acquisition of abilities already described in the literature facilitates the beginning of the implementation of a skull base team. Endonasal endoscopic surgery increases efficiency, has maximum functional preservation and demonstrates promising results, and should not be techniques in our environment exclusive to private practice.