Published in Acta Otorrinolaringol Esp. 2012; 63:339-47- vol.63 no.05
Introduction
The gradual increase in expertise of endoscopic endonasal surgery has enabled it to be used as a means of approach in the treatment of tumours which affect the skull base. We present our experience in the endoscopic treatment of those tumours.
Method
We present a retrospective study of the tumours treated during our work between 2004 and 2011 through an Endoscopic Endonasal Approach (EEA).
Results
Sixty-three patients were monitored. In 32 patients (51%) an endoscopic craniofacial resection was performed, in 22 patients (35% an extended EEA was performed, in 6 patients (9%) a transclival approach was performed and in 3 patients (5%) a transpterygoid approach was performed. The most commonly found benign tumour was nasopharyngeal angiofibroma (24%), while
adenocarcinoma was the most commonly found malignant tumour (30%). The average monitoring time was 26 months (ranging from 6 to 84 months). The rate of complications was 5% and resection was completed in 56 cases (89%). The survival rate for patients with malignant tumours was 71% five years after the procedure and for those with benign tumours; the success rate was 100%.
Conclusions
The results obtained allow us to confirm that extended endoscopic surgery at the skull base, with correct planning and execution, is a valid alternative to traditional open surgery approaches.
Key Words Endoscopy of the skull base. Craniofacial resection. Adenocarcinoma. Angiofibroma.

Otolaryngologists continue to be challenged by the treatment of tumours which affect the skull base due to the centrofacial localisation of these tumours and the proximity of vital neurovascular structures, the eyeball socket and the central nervous system. There is a wide range of benign and malignant neoplasms which can affect the skull base. The treatment of the majority of tumours which affect this area is based on surgical resection followed by postoperative radiotherapy; obtaining an overall survival rate of 50% - 60% over 10 years 1 (TN: after surgery). Nevertheless, for some histological types, the initial treatment consists of chemoradiotherapy, reserving surgery for treatment after a relapse. Surgical resection of these tumours is complex and requires a high level of specialisation. Open craniofacial approaches introduced by Ketcham et al 2 enable monoblock resection of a segment of the facial mass achieved through a combined transcranial and transfacial approach. The philosophy behind this approach was based on the observation that pure transfacial resection of tumours of the paranasal sinuses affecting the ethmoid roof was insufficient to ensure radical treatment. The development of extended anterior and lateral approaches has enabled the surgical resection of tumours which affect the ventral skull base. Although in the care of expert hands these approaches have significant levels of mortality; Ganly et al 3 reported postoperative mortality and major complications in 4.7% and 36.3% of patients respectively. Furthermore, in a study carried out by Fukuda et al 4 all patients demonstrate a decrease in quality of life, post-surgery, in relation to aesthetic or functional aspects. Since the end of the 90s Jho and Carru 5 , among others, have documented the use of endoscopic surgery for the resection of hypophyseal and sinonasal tumours, its indications have gradually increased and surpassed the limits established in the initial stages of the technique.
6 7 Endonasal endoscopic approaches (EEA) provide surgical access to the
1
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8 9 10 11 12
The evolution of these techniques has been influenced by the increase in surgical skills and better knowledge of the complex anatomy of the skull base.
13 As has been established in numerous studies,
(see footnote 10), EEAs enable the resection of lesions affecting the skull base in a way which is minimally invasive, with a lower mortality rate in comparison with open approaches, without compromising efficiency and oncological radicality. The purpose of this study is to present our experience of the treatment of sinonasal and skull base tumours through the use of an EEA.
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