Endoscopic Endonasal Approach To The Skull Base: The Learning Curve-Challenges, Tips And Tricks

Abstract

Introduction: The Endoscopic endonasal approach to the skull base developed from earlier exploits by the  Otolaryngologists who first used it for Sinus surgery. Since then, a lot has been developed regarding the number and extent of lesions that can be approached using the said technique. It has certainly become the preferred approach to Pituitary tumours over microscopic techniques.  The learning curve can be steep, especially where the support of more experienced colleagues or  Otolaryngologists is lacking. This paper reviews an account and guide to starting off and developing endoscopic techniques. Method: The presentation describes the challenges starting off on endoscopic surgery, and suggested mitigation measures and considerations. It follows with advancements in skill development over time allowing one to independently operate on several lesions proficiently only with the support of a less skilled assistant. Ideal case scenarios are presented to demonstrate good outcomes and less desirable outcomes too. Conclusion: Endoscopic endonasal surgery has developed into a preferred treatment method for several skull base lesions. Going forward endoscopic skills shall start to make part of the vital armament needed by the future Neurosurgeon. Training, mentorship, and other means of skill transfer need to be increased to develop endoscopic work further.