%0 Journal Article
%T Expanded Endoscopic Endonasal Approach to Anterior and Ventral Skull Base: An Evolving Paradigm
%A Balwant Singh Gendeh
%J ISRN Endoscopy
%D 2013
%R 10.5402/2013/149841
%X The transition from external approaches to an endonasal corridor has seen a significant decline in patient morbidity and inpatient care. Our Rhinology and Cranial Base Surgery Group has been able to focus on the management of certain pathologies, endoscopic access to various areas in the skull base, reconstruction of the defect, ensuring that clear anatomical landmarks can be identified during the surgery, and improving the quality of life/function after treatment. The focus on surgical treatment is always to control disease and cure patients by not only reducing recovery time and perioperative morbidity, but also decreasing the long-term impact of having a tumour removed. With a dedicated combined operating theater setting with updated instrumentation, the Neuro-ENT team is able to continue to expand and develop endoscopic care for a greater number of patients and wider range of pathologies. The collaborative Neuro-ENT to work closely via the nose using the two-hole and four-hand technique when performing the operation simultaneously is of added advantage in the diverse and expanding field of cranial base surgery. Our skull base team is joined by expert radiation and medical oncologists who provide essential adjunctive care in the multidisciplinary management of these patients. 1. Introduction Skull base surgery is a dynamic subspecialty and the last decade has witnessed the application of endoscopic techniques to the ventral skull base using an endonasal corridor (Figure 1). The transition from external approaches to an endonasal corridor has seen a significant decline in patient morbidity and inpatient care. Multidisciplinary collaborations in managing complex pathologies of the skull base have defined the nascent field of Neurorhinology. For lesions encompassing the ventral skull base and paranasal sinuses, this interaction with multiple specialities, notably otolaryngologists and neurosurgeons, has allowed procedures to be developed that offer significant advantages over treatment modalities from 25 years ago. As technological advancements and novel surgical instruments were developed for use in inflammatory disorders, otolaryngologists, with neurosurgeons, have begun to perform complex procedures endoscopically via the nostrils. In Malaysia, our center is at the forefront of skull base surgery. Common endoscopic skull base tumour surgery at our center includes meningioma, pituitary tumours, craniopharyngiomas, and chordomas. Additionally, our tertiary referral center provides endoscopic approaches to some vascular lesions and the latest management
%U http://www.hindawi.com/journals/isrn.endoscopy/2013/149841/