Introduction: The conventional microscope-based technic has been the gold standard in the transnasal surgery of central skull base tumors for many years. Nonetheless, over the past 2 decades, a clear shift has been observed towards the endoscopic techniques. Main advantage of the procedure is the superior visualization and maneuverability without using a nasal speculum. This allows safe surgical dissection and extension of nasal indications by large skull base tumors.
Methods and Results: In all cases, procedures are performed interdisciplinary in a 4-hand technique. The surgical plan is considered and tailored depending on individual tumor location and extension, as well as, the anatomical nasal conditions of each patient. Small, midline tumors are approached by a direct paraseptal approach. The most commonly used “work horse approach” is the trans-ethmoidal paraseptal route. Large tumors are approached via binostril exposure, or even via a combined transnasal / transcranial route. Using the tailored concept we are able to generate enough working space through the nose without compromising the olfactory mucosa and without removal of nasal turbinates.
Conclusion: Our interdisciplinary rhino-neurosurgical teams in Zürich, Budapest and Debrecen has been established the concept for minimal-invasive tailored transnasal endoscopic approach. The design of a structured, case-specific, surgical plan allows the surgical treatment of all anterior skull-base tumors, going from small midline tumors to large extensive ones (a.e. chordomas, craniopharingiomas, sarcomas, and aesthesioneuroblastomas).
