Neuroendoscopic Transnasal Skull Base Approach

概要

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With the recent advent of endoscopic technology, the role of transnasal surgery has been remarkably enlarged in skull base surgery. In the endoscopic skull base approach, we can access a wide range of skull base regions including the anterior cranial base, the parasellar region, the clivus, the cavernous sinus, and the craniovertebral junction. Endoscopic skull base surgery is relatively easy to master compared to conventional skull base surgery with a microscope, but there are some points that should be remarked upon. In this article, we present the basic approach methods for endoscopic skull base surgery. There are 2 major approaches, the endonasal approach and the transseptal approach. Based on these two basic approaches, we recently infroduced a new approach, the binostril transseptal approach, in which we can use two nostrils and retain a sufficient surgical field with only small incision in the septum. It is very important to avoid the excessive mucosal damage and to select the appropriate approach in each patient. The endoscopic skull base approach is one of the least invasive surgical procedures, which is also a very promising therapeutic choice with the potential of further advancement. This article will contribute to the pursuit of safe and effective surgical procedures to treat patients suffering from intractable skull base lesions.