Journal of Neuro-Oncology

, Volume 130, Issue 2, pp 319–330 | Cite as

Endoscopic transnasal skull base surgery: pushing the boundaries

  • Nathan T. Zwagerman
  • Georgios Zenonos
  • Stefan Lieber
  • Wei-Hsin Wang
  • Eric W. Wang
  • Juan C. Fernandez-Miranda
  • Carl H. Snyderman
  • Paul A. GardnerEmail author
Topic Review


The endoscopic endonasal approach (EEA) has significantly evolved since its initial uses in pituitary and sinonasal surgery. The literature is filled with reports and case series demonstrating efficacy and advantages for the entire ventral skull base. With competence in ‘minimally invasive’ parasellar approaches, larger and more complex approaches were developed to utilize the endonasal corridor to create maximally invasive endoscopic skull base procedures. The challenges of these more complex endoscopic procedures include a long learning curve and navigating in a narrow corridor; reconstruction of defects presented new challenges and early experience revealed a significantly higher risk of cerebrospinal fluid leak. Despite these challenges, there are many benefits to the EEA including avoidance of brain and neurovascular retraction, improved visualization, a direct corridor onto many tumors and the two-surgeon approach. Most importantly, the EEA provides a midline corridor to directly access tumors, which displace critical neurovascular structures laterally, giving it an inherent advantage of minimizing any manipulation of these structures and thus decreasing their potential injury.


Endoscopic endonasal approach Endoscopic endonasal surgery Skull base Transclival Transcribriform Transpterygoid 

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nathan T. Zwagerman
    • 1
  • Georgios Zenonos
    • 1
  • Stefan Lieber
    • 1
  • Wei-Hsin Wang
    • 1
  • Eric W. Wang
    • 2
    • 3
  • Juan C. Fernandez-Miranda
    • 1
    • 3
  • Carl H. Snyderman
    • 1
    • 2
    • 3
  • Paul A. Gardner
    • 1
    • 3
    Email author
  1. 1.Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of OtolaryngologyUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.UPMC Center for Cranial Base SurgeryPittsburghUSA

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