Endoscope Assisted Skull Base Surgery

What is it?

Skull Base surgery involves operations on conditions affecting the bones of the base of the skull, or operations performed via the base of the skull to access the brain and avoid pushing on the brain.

The image below is a view from above into the inside and base of the skull. The red shaded areas show the skull base.

Within the structures of the skull base are most of the nerves of the face, the eyes and their nerves and blood vessels, the major blood vessels to the brain, nerves controlling balance and hearing, and the connection between the brain and spinal cord.

Historically, access to the skull base, particularly the area between the nose and the very back of the throat has been accessed by either opening the skull and gently retracting the brain, or by removing or taking apart the structures of the nose, upper jaw and lower jaw. Clearly this is a major undertaking and carries many risks.

The development of endoscopic (telescopic) operations via the nose and also the mouth has allowed surgeons to access these areas with no brain retraction, and vastly reduced damage to the structures of the face. This group of operations are called expanded endonasal endoscopic operations. Below is an image through the skull and brain demonstrating a tumour of the base of the skull at the back of the nose and throat. The skull base is shaded red, the tumour purple, and the white lines show the extent of the access to this region of the skull via the nose using an endoscope.

The endoscope is generally introduced via the nose, and additional instruments introduced via the other side of the nose. The operation is often performed by a team of surgeons, one of whom is often an ear nose and throat surgeon working together with the neurosurgical team.

How can we use these techniques?

Below is is list of problems that can be dealt with using these techniques

Pituitary tumours
Rathke’s Cleft Cyst
Suprasellar Meningioma
Olfactory groove and anterior fossa meningioma
Clivus Chordoma and Chondrosarcoma
Petroclival Cholesteatoma
Cerebro-spinal fluid lead
Biopsy of Skull based tumours of uncertain origin