Article

During the last two decades, endoscopic endonasal approach has completed the
minimally invasive skull base surgery armamentarium. Endoscopic endonasal skull
base surgery (EESBS) was initially developed in the field of pituitary adenomas,
and gained an increasing place for the treatment of a wide variety of skull base
pathologies, extending on the midline from crista galli process to the
occipitocervical junction and laterally to the parasellar areas and petroclival
apex. Until now, most studies are retrospective and lack sufficient
methodological quality to confirm whether the endoscopic endonasal pituitary
surgery has better results than the microsurgical trans-sphenoidal classical
approach. The impressions of the expert teams show a trend toward better results
for some pituitary adenomas with the endoscopic endonasal route, in terms of
gross total resection rate and probably more comfortable postoperative course for
the patient. Excepting intra- and suprasellar pituitary adenomas, EESBS seems
useful for selected lesions extending onto the cavernous sinus and Meckel's cave
but also for clival pathologies. Nevertheless, this infatuation toward endoscopic
endonasal approaches has to be balanced with the critical issue of cerebrospinal
fluid leaks, which constitutes actually the main limit of this approach. Through
their experience and a review of the literature, the authors aim to present the
state of the art of this approach as well as its limits.
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- Historique

Langue : FRANCAIS