Objective: To describe the evolution of extended endoscopic surgery of the skull base, with current and future applications.
Setting: Manchester Skull Base Unit, Salford Royal Hospital, Salford, Manchester, UK.
Methods: A literature search of Medline, EMBASE, CINAHL, AMED and the Cochrane Database of Systematic Reviews using the Ovid Collection was conducted to identify scientific publications using keywords including expanded endonasal approach, extended endoscopic endonasal approach, skull base surgery, and endoscopic skull base surgery. The period searched was 1948 to September 2013.
Results: 115 papers were identified. 48 Review articles, 26 case series and 41 technical notes were included for discussion.
Discussion: Evolution of endonasal endoscopic surgery in recent decades has produced a paradigm shift in the management of sinonasal and anterior skull base pathology. Burgeoning indications for the expanded endonasal approach to treat skull base and adjacent pathology has led to a rapid advancement in this field. Combined improvements in technology, such as intraoperative navigational systems, specialised instrumentation, compilation of endoscopic anatomical studies and surgical experience, have ratified change. In an increasing number of centres, it is considered the gold standard surgical approach, even for extensive pathology.
Conclusions: The frontiers of endoscopic transnasal surgery are ever expanding as new approaches emerge to manage ever more inaccessible lesions.