Otolaryngology: Open Access
Open Access

The skull base is a complex anatomical region housing critical neurovascular structures. Traditional open approaches require extensive craniotomies, often leading to significant postoperative morbidity. ESBS, developed over the past few decades, has revolutionized the management of skull base lesions by utilizing endoscopic visualization and transnasal access routes. The skull base is one of the most anatomically complex and functionally critical regions of the human body, serving as the interface between the brain, cranial nerves, and vital vascular structures [1]. Traditional open surgical approaches to skull base lesions often require extensive craniotomies, facial incisions, or mandibular splitting, which can result in significant postoperative morbidity, extended recovery periods, and increased risk of complications such as infections, cerebrospinal fluid leaks, and neurovascular injuries. With advancements in endoscopic technology and surgical techniques, ESBS has emerged as a revolutionary approach that provides direct access to the skull base through natural corridors, such as the nasal cavity, eliminating the need for large external incisions. This approach allows for enhanced visualization of deep-seated lesions with minimal disruption to surrounding structures. The application of endoscopy in skull base surgery has evolved significantly, providing high-definition magnification, improved illumination, and angled optics, which facilitate precise tumor dissection and resection in challenging anatomical regions. The primary objectives of ESBS include maximizing tumor removal while preserving critical neurovascular structures, reducing surgical morbidity, and improving patient outcomes. A multidisciplinary collaboration between neurosurgeons and otolaryngologists is essential for optimizing surgical planning, intraoperative navigation, and postoperative management. In this article, we discuss the indications, surgical techniques, benefits, challenges, and future directions of ESBS, highlighting its role as a minimally invasive yet highly effective approach for treating complex skull base lesions [2-4].

Discussion

The emergence of ESBS has significantly improved the management of skull base pathologies, particularly in cases where traditional open surgeries posed substantial risks. One of the most compelling advantages of ESBS is its ability to provide superior visualization of deep-seated structures through high-definition endoscopes. This results in improved tumor resection rates and greater preservation of adjacent neurovascular structures. A key area of ongoing discussion is the comparison between ESBS and conventional open approaches in terms of patient outcomes. Studies have demonstrated that ESBS results in shorter hospital stays, reduced postoperative pain, and a lower incidence of complications, making it the preferred choice for many benign and some malignant lesions. However, critics argue that the learning curve associated with ESBS is steep, requiring extensive training and experience to master.

Despite its many advantages, ESBS is not without its limitations. One of the major concerns remains the risk of cerebrospinal fluid (CSF) leaks, which can lead to serious complications such as meningitis. Advancements in reconstruction techniques, including the use of vascularized flaps like the nasoseptal flap, have helped mitigate these risks. Additionally, intraoperative neuronavigation and augmented reality tools are being increasingly utilized to enhance precision and safety. Another topic of interest is the expansion of ESBS into managing malignant tumors. While ESBS has shown success in removing select malignant tumors, its role remains limited due to challenges in achieving wide oncologic margins. Adjuvant therapies such as radiation and chemotherapy are often required to ensure comprehensive tumor control. Future research is focused on improving these outcomes and exploring novel adjuvant treatment strategies. Technological innovations continue to push the boundaries of ESBS. The integration of robotic assistance in endoscopic procedures is being explored to enhance dexterity and precision. Additionally, real-time intraoperative imaging and AI-assisted surgical planning are expected to play a crucial role in the future of ESBS. Overall, ESBS represents a paradigm shift in skull base surgery, offering a minimally invasive yet highly effective alternative to traditional methods. While challenges remain, ongoing advancements in surgical techniques, instrumentation, and adjuvant therapies are expected to further improve patient outcomes and expand the indications for ESBS [5].

Conclusion

Endoscopic skull base surgery is a groundbreaking, minimally invasive approach for managing complex skull base lesions. Continuous technological advancements will further enhance its effectiveness, making it an essential tool in modern neurosurgical and otolaryngological practice.  

Acknowledgment

None

Conflict of Interest

None

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