Endoscopic Endonasal Ethmoid-Pterygoid Transsphenoidal Approach to the Cavernous Sinus

Abstract

In the last decades, endoscopic endonasal approach has gained a relevant role among the surgical approaches for cavernous sinus tumors. Indeed, this route allows the surgeon to follow the extension of the tumor into the cavernous sinus though a direct, straightforward, and completely extracranial route. Thus, it allowed to combine the high versatility of the endoscopic technique to the greater tolerability given by the endonasal transsphenoidal route. Along these years of adoption, this surgery has demonstrated its safety and effectiveness, with a low risk of permanent neurological sequelae and a good outcome for well-selected tumors. Indeed, the endoscopic endonasal approach should not be considered as a “magic bullet” for all cavernous sinus tumors. Its indications should be well considered, and even if it can be the first choice for many cases, mainly pituitary adenomas and chordomas or chondrosarcomas, in the hands of a properly trained endoscopic endonasal surgeon in a well-equipped surgical center, it is just only one of the weapons that a skull base surgeon should have in his arsenal to face these demanding diseases.