Surgery of complex skull base tumors is a great challenge, because of the complicated bony and essential neurovascular structures involved. It makes it even more difficult that the extent of resection of skull base tumors often determines patients’ outcome. Technical development increased the accuracy and effectiveness of skull base surgery, placing endoscopic approaches as gold standard in various aspects from anterior skull base to clival surgery. However, in cases of complex tumors of the skull base combined (endoscopic plus transcranial) surgical approaches ensure optimal, patient-specific, and complete removal and better outcome. Supporting this concept, we present cases of our recent practice of combined tumor removal from the anterior skull base and paranasal sinuses as well as from the clival region. We demonstrate that combination of novel skull base approaches and classical routes seems to be ideal to achieve total tumor removal in a patient-specific manner and best outcome in this patient population.

This work was supported by grants from the National Research, Development and Innovation Office (OTKA K-134555, OTKA FK-146334), National Clinical Neuroscience Laboratory (RRF-2.3.1-21-2022-00011), the Thematic Excellence Program 2021 Health sub-programme of the Ministry for Innovation and Technology in Hungary, within the framework of the EGA-16 project of the University of Pecs.