Endoscopic Management of Anterior Skull Base Lesions: Experience of Tertiary Care Center in India

Background Endoscopic management is the preferred approach for majority of anterior skull base lesions. Controversy still exists regarding the outcomes with respect to certain aggressive pathologies.

Objectives To review the outcomes of different anterior skull base pathologies managed by pure endoscopic technique.

Methodology A retrospective review of our institutional cases was done (January 2015–June 2017). All anterior skull base lesions managed by pure endoscopic technique were included in the review. Cases managed by external or endoscopic-assisted techniques were excluded. Cerebrospinal fluid (CSF) rhinorrhea cases with no herniation of brain tissue were excluded from the study. A total of 37 cases were included for review. The patients were evaluated with regard to hospital stay, blood loss, complications, margin status, and disease-free survival.

Results The pathologies evaluated are as follows:

• Glioma (Pediatric: 1)

• Neurofibroma (Pediatric: 1)

• Osteochondromyxoma (Pediatric: 1)

• Invasive fungal sinusitis (Pediatric: 1)

• Juvenile nasopharyngeal angiofibroma (Pediatric: 2)

• Inverted papilloma with skull base erosion (5)

• Inverted papilloma with synchronous malignancy (1)

• Solitary fibrous tumor (1)

• Squamous cell carcinoma of ethmoids (1)

• Adenocarcinoma of paranasal sinus (ethmoid sinus) (2)

• Undifferentiated ethmoidal carcinoma (3)

• Olfactory neuroblastoma (2)

• Invasive fungal sinusitis (adult: 2)

• Pneumoencephalocele (2)

• Schwannoma of PNS (V2 & ethmoidal nerve) (2)

• Meningoencephalocele with CSF leak (5)

• Angiofibroma with intracranial extension (4)

• Ameloblastoma (1)

The age range was from 4 days to 62 years. The average hospital stay in pediatric age group was 5.2 days and in adults was 5.3 days. The average blood loss in pediatric and adult patients was 189 and 368 mL, respectively. The margin positivity in histopathology was 18.9%.

The complications encountered were as follows:

• Blood transfusion reaction

• Facial numbness

• Recurrence in vidian canal

• Anosmia

• Secondary hemorrhage

• CSF leak

• Meningitis

• Requirement of adjuvant treatment

• Frontal sinusitis

• Ophthalmoplegia (temporary)

Conclusion Endoscopic approach helps reduce blood loss, hospital stay, and complications in comparison to external approaches. It can be considered the gold standard for majority of benign disorders. However, the margin negative rates are similar to traditional approaches. A small subset of malignant pathologies can be planned for endoscopic management with adequate preoperative planning and mandatory close postoperative follow-up.