Endoscopic approaches to the cranial base: perspectives and realities

We describe the development of transnasal endoscopic approaches to the cranial base in an interdisciplinary series of 103 patients, including 13 in the pediatric age group. Our aim was to define, with the aid of different case reports, the possibilities of endoscopic techniques in tumor resection, fistula repair, the treatment of mucoceles and meningoceles, and of combined intracranial and endoscopic approaches. The advantages of these minimally invasive approaches are panoramic visualization, rapidity and reduction of the cosmetic and functional disabilities in comparison with other conventional approaches, and a better capacity for identifying and developing key landmarks for surgery. On the other hand, endoscopic surgery requires an exsanguine operation field, technical improvements in instruments, and specific skills. Interdisciplinary collaboration in endoscopic approaches has proved useful in integrating experiences without overlap between fields, and in broadening possibilities: in our opinion endoscopic approaches will certainly be important in the future of cranial base surgery.