الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 181 |  |  |
| | | from | 181 | | |
Abstract
The cranial base constitutes an anatomic boundary between the fields of neurosurgery and otolaryngology. Surgery in this region has always been a challenge for both isciplines. Transsphenoidal approaches to the ventral midline skull base were first proposed more than a century ago. Initially these approaches were restricted to the pituitary fossa, but with progressive evolution in biotechnology, coupled with increased anatomical understanding, the transsphenoidal approaches were extended to regions beyond the sellaturcica to include other entities in addition to pituitary tumors. The introduction of the operating microscope by Hardy in the 1960s, coupled with Dott’s contribution of fluoroscopy, provided the first critical navigation/visualization integration that formed the foundation of the work that followed. The addition of the endoscope, coupled with the current sophisticated neuronavigation systems, builds on this foundation. The expanded endonasal approach evolved when these principles were then further augmented with the concept of team surgery; that is, a neurosurgeon and otolaryngologist working simultaneously throughout all phases of the surgery (approach, resection, and reconstruction). Using the principles of the expanded endonasal approach, we are now able to access the entire ventral skull base, from the crista galli up to and through the odontoid, and we are able to address a diverse array of intra- and extradural entities. The endoscopic endonasal trans-sphenoidal approach for skull base tumors is a minimally invasive surgery preserving the nasal structures thus facilitating faster postoperative recovery. It offers a panoramic view of the sphenoid sinus with visualization of the corners of the sellar and suprasellar structures with increased illumination and magnifications. Such visualization provides a potential for more complete tumor removal with preservation of pituitary function and very low rate of complication. Finally, we still need time to increase our skills and experience to master this approach and to improve our results regarding total excision of skull base tumors other than pituitary adenoma. We feel that the advantages of the endoscopic approach will make this technique the favored approach for future treatment of skull base lesions