ENDOSCOPIC SKULL BASE SURGERY via the Endoscopic Endonasal Approach (EEA)

January 1, 2017 VIVEN RAJAH Nasal Sprays 

Endoscopic endonasal  skull-base surgery is a minimally invasive surgical technique performed through the nose in order to remove brain tumors, pituitary tumors, and other lesions at the base of the skull, through the nasal passages. This procedure often takes less than four hours to complete and patients typically go home in a few days. Patients who have this procedure done typically have shorter anesthesia times, improved outcomes, faster recovery, less pain, and no scars compared to traditional open brain surgery.

A multidisciplinary team of neurosurgeons and otolaryngologists perform these operations as combined procedures

With the endoscopic endonasal approach (EEA), surgeons reach tumors and lesions of the skull base and top of the spine directly by operating through the nose and sinuses. A specially designed endoscope provides light and a lens for viewing and transmitting internal images. Highly crafted instruments are used alongside the endoscope for dissection and tumor removal. These surgeries are performed in dedicated operating theatres  that incorporate sophisticated imaging technology.

This minimally invasive approach uses the nose and sinuses as natural corridors to access tumors and lesions in critical areas at the base of the skull or top of the spine. The Endoscopic Endonasal Approach allows surgeons to treat many hard-to-reach tumors, even those once considered “inoperable,” without disturbing the face or skull

The concept of team surgery has allowed us to expand the role of the Endoscopic Endonasal Approach (EEA) to include all pituitary tumors, regardless of size or invasiveness, and to access tumors of the skull base from the frontal sinus all the way down to the upper cervical spine and out to the cavernous sinus, Meckel’s cave, jugular foramen and beyond.

What is the skull base?

The skull base (or cranial base) is the part of the skull (cranium) that supports the brain and separates the brain from the rest of the head. Blood vessels to the brain and nerves from the brain (cranial nerves) run through holes in the skull base. Below the skull base are the nasal passages, sinus cavities, facial bones, and muscles associated with chewing.

What will happen before EEA surgery?

If surgery is recommended, additional testing is often necessary. This may include visits with additional specialists, medical clearance from your primary physician or anaesthetist, and medical tests. CT and MRI scans are often obtained before surgery for use with an image guidance system akin to a GPS of the brain and skull base.

In recent years, the transnasal endoscopic approach to the ventral midline skull base has rapidly become a widespread procedure. In fact, this approach occupies a crucial place in the armamentarium of neurosurgeons and otorhinolaryngologists for the management of diseases of the anterior skull base, the sella, the suprasellar and parasellar regions.