Endoscopic Transnasal Approach to the Anterior Skull Base: A Replacement for Maxillotomy Techniques?

Purpose of the Study: To investigate the efficacy of transnasal endoscopic approaches for anterior skull base pathologies.

Design: Retrospective study.

Material and Methods: We reviewed the medical notes and imaging of 15 consecutive patients treated by transnasal endoscopic surgeries (9 male, 6 female) for skull base lesions from 2007–2012. We recorded the preoperative symptoms, symptom duration, length of postoperative hospital stay, complications, and adequacy of tumor resection.

Results: A total of 18 procedures were performed in 15 patients. Mean age at operation was 38 years. Mean duration of symptoms was 27 months. Procedures were performed for: eight clival chordomas (5 primary, 3 revision), one clival chondrosarcoma, one fibrous dysplasia, one adenocarcinoma, one clival metastasis from hepatocellular carcinoma, one pituitary adenoma, one optic nerve meningioma, three odontoid peg resections, and one nonspecific benign clival lesion. Two patients underwent occipitocervical fixation. Mean surgical time was 172 minutes. Postoperatively, patients were intubated for a mean time of 1 day, with a mean ITU stay of 1 day, and duration of hospital stay a mean of 9 days. There were two intraoperative complications: one dural tear and one internal carotid artery injury. There were two postoperative complications in the same patient: CSF leak needing return to surgery and brain infarct. Mean follow-up was 19 months. Adjuvant therapy was given in 50% of patients (proton beam in three, radiotherapy in three, and chemotherapy in one). One patient died due to progression of the disease.

Conclusion: The endoscopic approach to the anterior skull base is a minimally invasive and a safe alternative to the traditional maxillotomy approach.