Introduction: The idea of multidisciplinary approach and increasing experience with endoscopic transnasal surgery and extended endoscopic approaches, such as transpterygoid, opened a wide range of indication of endoscopic surgery on skull base tumors. However, there are anatomical limitations of pure endonasal approach.
Aims: To identify cases that require combined approach, either with transcranial or with transorbital extension. We also aimed to define the optimal timing of the two approaches, knowing the fact that a simultaneous biportal operation may unnecessarily increase the risk of surgery.
Methods: Retrospective analysis of 133 joint neurosurgical-rhinological endoscopic transnasal operations performed in three locations between 2019 and March 2024. Of these, 15 patients underwent combined approach either in single or in staged sessions.
Results: 8 patients underwent single session combined endoscopic transnasal and transcranial, 2 patients had single session combined endoscopic transnasal and transorbital operation, and 5 patients underwent staged surgeries. Seven of the patients (47%) underwent previous operation. Of the single session transcranial patients, 2 had benign, 2 semimalignant, and 4 (50%) malignant tumors, whereas 1 had benign and 1 semimalignant with orbital pathology. In the staged group, 4 (80%) had benign and 1 had malignant tumor. Three patients had septic complication (20%), 2 (13%) had new neurological deficit and 1 had systemic complication after surgery. One patient died with 30 days and one within one year due to surgical complications (both patients underwent single session surgery and both had septic and neurological complication), both underwent single session operation, and one due to disease progression of malignant tumor.
Two patients required ventriculo-peritoneal shunting due to postoperative hydrocephalus.
Conclusion: The management of complex skull base tumors remains challenging. With the utilization of endoscopic transnasal, transcranial and transorbital corridors, with multiple techniques of skull base reconstruction, and optimal planning and timing we may be able to further improve outcome.
Funding: none.