Skull Base Surgery

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Skull Base Surgery


Skull base is one of the most varied anatomical challenges of the human body. Approach is fraught with problems of access to important physiological structures. Endoscopes with cold light system and cameras have improved access and visualization, thus brightening up the field of surgical interest enabling one to see and approach every niche and corner of this intricate and complex area. Endoscopes can reach areas directly without disturbing anatomy, which conventional surgery would need to go through important structures to achieve the same results. Thus, it is minimally invasive, reducing the morbidity and performing precisely and effectively.

Aftercare becomes easier, reducing the period of hospitalization as well.

The list of indications with this approach appears to be increasing as more and more people are using the endoscopic way.

Skull Base Surgery
Indications for endoscopic or combined approach:
  • Pituitary tumors
  • CSF rhinorrhea
  • Tumors of the nose and paranasal sinuses which have gone intracranial
  • Approach to clivus
  • Approach to nasopharyngeal lesions
  • Approach to orbit:
  • Optic nerve decompression
  • Thyroid orbitopathy
  • DCR
  • Orbital decompression
  • Orbital tumors
  • Orbital abscess
  • Mucoceles going intra-orbital

This list would get longer with experience.

  • In 1900 HALSTEAD used nose to approach brain tumors like Pituitary
  • CUSHING was the one who made this approach popular
  • 1980 Messerklinger and Wigand used Endoscopes for nose and sinuses and to treat difficuly problems of the eye and brain

    Injury to eye Nerve can be devastating in terms of loosing eyesight and needs quick treatment with the help of endoscopes

Injury to vision nerve
  • Can be Direct or Indirect
    • Direct may result in physical disruption or shearing of fibers
    • Very rarely it may be result of Surgery
    • Prompt decompression of the vision nerve may restore the eyesight
CSF Rhinorrhoea
  • This a condition where clear water flows out of the nose , mostly from one nose because of rent or crack in the skull base. This is best treated through the nose with help of Endoscopes to avoid injury to the patient by opening the brain and its associated Mrbidity.
  • Tumors of the brain located at the base of skull are approached through the nose without going through brain surgery. This can avoid the morbidity of opening the brain and tumurs like Craniopharyngioma, seen in the images, can be removed through the nose using Endoscpes.
  • Tumor of skull base affecting vision
Conceptually Different
  • When we treat tumors of the brain thru the nose we move from Minimally Invasive to Maximally Invasive
  • This requires a Teamwork
  • Instruments are very important with two nostril four hand approach
  • Endoscopic Approach to Pituitary tumour removed successfully
  • Other lesions of base of skull which can be treated with satisfaction like this patient suffering from Clivus Chordoma
  • Bloody tumors like Nasopharyngeal Angiofibroma can also be treated after embolization Endoscopically or with open surgery