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Abstract
Introduction: As the experience with endoscopic sinus surgery has developed the procedures, the instruments and the equipments have been found to suit the treatment of lesions of the anterior and central skull base. Aim of the work assessment of the safety & efficacy of transnasal endoscopic surgical approaches in treating large scale of accessible skull base related disorders. Results: We have collected 122 cases distributed as follows: 36 pituitary adenomas, 8 craniopharyngiomas, 26 C.S.F leak, 5 meningiomas, 8 meningoceles, 7 meningoencephaloceles, 6 juvenile nasopharyngeal angiofibromas, 5 inverted papillomas, 3 olfactory neuroblastomas, 6 orbital compressing lesions, 7 optic nerve compressing lesions, 3 clival chordomas and 2 petrous apex cholesterol granulomas Age range was (2-76) y with the mean = 42+/-16.95, 61.5% males, 92.6% were virgin cases. We have used exclusively endoscopic approaches in 94.3% of our cases Mean operative time was 144.14 +/- 102.714 minutes. 86.1% of our cases needed no intraoperative blood transfusion. Mean postoperative pain duration in days was 1.24 - 0.53, mean postoperative ICU stay in days was 0.57 +/- 0.49 & mean postoperative hospital stay in days was 4.59 +/- 0.613. 82% of our surgeries passed without noticeable intraoperative complications. In the remaining 18% we were able to discover and manage these complications ‘such as C.S.F leaks or dural sinus bleeding’ in the same setting and through the same approach. 87.7% of our cases passed without noticeable postoperative complications, 6.6% had common complications that could follow any standard FESS procedure in the form of postoperative bleeding & C.S.F leak, the remaining 5.8% of our cases (who developed persistent diabetes insipidus or other forms of pituitary insufficiency belongs to the sella related lesions categories and the incidence of these 2 complications among them was 6.12% and 8.16% respectively. We were able to completely achieve our goal in 95.86% of cases. The percentage of recurrent or residual lesions in all cases was 9.8%, all of them were managed successfully whether through the same endoscopic approach or even with a less invasive measure like the stereotactic treatment, which we relied on in 75% of our management of recurrent or residual cases). Conclusion: The present study confirms the reports of several other investigators regarding the safety and efficacy of endoscopic surgical techniques applied to a wide variety of lesions of the anterior and central skull base that could be only previously reached by open surgical approaches putting in consideration their great disabling outcomes. On the other hands, there are some limitations that prevent globalization and standardization of the endoscopic approach to be the best approach for all accessible skull base lesions for example; the site, size and extension of tumor, necessity for an en bloc removal of the tumor with adequate safety margin in case of malignancy, the high cost and the sophistication of the auxiliary equipments and of course the need for mastering the endoscopic endonasal surgical techniques.