Endoscopic Approaches in Skull Base Surgery Techniques

Endoscopic techniques have revolutionised access to the skull base by replacing extensive open craniotomies with minimally invasive corridors. High-definition rigid endoscopes, angled optics and neuronavigation systems enable direct midline visualisation through transnasal, transpterygoid, transcribriform and transorbital routes. These approaches permit resection of pituitary adenomas, meningiomas and other ventral skull base tumours, as well as repair of cerebrospinal fluid defects, while reducing brain retraction, postoperative pain and hospital stay. Multilayer reconstruction using vascularised flaps, synthetic grafts or autologous tissue has been refined to minimise postoperative leaks. Mastery of complex three-dimensional anatomy, an understanding of critical neurovascular structures and a structured training pathway are essential to overcome the steep learning curve. Ongoing integration of intraoperative imaging, fluorescence guidance and augmented reality promises further enhancements in safety and efficacy, broadening the clinical indications and global adoption of endoscopic skull base surgery.

Research from Nature Portfolio

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Research from all publishers

Recent work has introduced a collaborative human–computer vision algorithm for analysing endonasal operative videos. The system reliably detects surgical interruptions and phase transitions with over 93% accuracy, reducing review time by up to 86% and offering objective metrics to support trainee assessment. A systematic review and meta-analysis of endoscopic transsphenoidal pituitary surgery identified higher body mass index, larger and invasive tumours, harder tumour consistency, intraoperative cerebrospinal fluid leakage and revisional operations as significant predictors of postoperative cerebrospinal fluid leak. These findings have informed risk-adapted reconstruction strategies and perioperative management protocols. In parallel, anatomical studies combining cadaveric dissections with pooled clinical series have characterised transorbital corridors to the ventral skull base. Detailed mapping of orbital and parapharyngeal landmarks across 193 patients demonstrated feasibility, low morbidity and specific indications for lateral sphenoid, infratemporal and upper parapharyngeal access, reinforcing the value of transorbital endoscopy as a complementary approach.

Endoscopic Approaches in Skull Base Surgery Techniques publication trend

The graph below shows the total number of articles in endoscopic approaches in skull base surgery techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Endoscopic endonasal approach (EEA): Minimally invasive access to the ventral skull base via the nasal cavity using rigid endoscopes and specialised instruments.

Transorbital approach: Endoscopic corridor through the orbit to reach lateral and ventral skull base regions, defined by orbital rims and periorbital soft tissue.

Cerebrospinal fluid leak (CSF leak): Unintended escape of cerebrospinal fluid through a dural or bony defect, often requiring multilayer closure.

Skull base reconstruction: Techniques to repair dural and osseous defects after tumour resection, employing flaps, grafts or sealants to restore barrier integrity.

References

1. Collaborative Human–Computer Vision Operative Video Analysis Algorithm for Analyzing Surgical Fluency and Surgical Interruptions in Endonasal Endoscopic Pituitary Surgery: Cohort Study. Journal of Medical Internet Research (2024).
2. Risk factors of cerebrospinal fluid leakage after neuroendoscopic transsphenoidal pituitary adenoma resection: a systematic review and meta-analysis. Frontiers in Endocrinology (2024).
3. Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description. Neurosurgical Review (2021).