Skull Base Neurosurgery

Series 3. The Endoscopic Endonasal Approach to other Skull Base Tumours

Skull base tumours have presented a major challenge to neurosurgeons. The area is full of important blood vessels and nerves and access to these vital areas is complicated by cosmetically important structures, functionally vital anatomy and overlying sensitive brain. As a result, removal of tumours from the skull base is reserved for surgeons who have received special training in these techniques.

Until now, the operations were time consuming, quite destructive and associated with considerable morbidity. At the Centre, we offer a minimally invasive, keyhole approach to many lesions that would otherwise need very destructive operations.

The following is an example of this philosophy. The first scan shows a tumour of the anterior skull base floor.

It is a meningioma that most neurosurgeons would remove through a large ear-to-ear incision, a bi-frontal craniotomy (window in the skull) and substantial retraction of the overlying brain. This tumour was removed entirely through the nose using advanced endoscopic techniques.

There was no brain retraction, no neurological complications, no scar and absolutely no pain. The patient was discharged from the hospital on the second post-operative day.

The post-operative scan shows a complete removal and the next picture shows the patient the day after surgery.