Endoscopic endonasal skull base surgery: past, present and future

Endoscopic techniques have undergone tremendous advancement in the past years.
From the management of phlogistic pathologies, we have learned to manage skull
base lesions and even selected intracranial diseases. Current anatomical
knowledge plus computer-aided surgery has enabled surgeons to remove large
lesions in the paranasal sinuses extending beyond the boundaries of the sinuses
themselves. In this sense, management of benign diseases via endoscopic routes is
nowadays well accepted whilst the role of endoscopic techniques in sinonasal
malignancies is still under investigation. Nowadays, it is possible to tackle
different pathologies placed not only in the ventral skull base, but also
extended laterally (infratemporal fossa and petrous apex) and even, in really
selected cases, within the orbit. The ability to resect and reconstruct has
improved significantly. At the moment, the improvement in surgical techniques,
like the four-handed technique, has rendered endoscopic procedures capable of
managing complex pathologies, according the same surgical principles of the open
approaches. From now onwards, frameless neuronavigation, modular approaches,
intraoperative imaging systems and robotic surgery are and will be an
increasingly important part of endonasal surgery, and they will be overtaken by
further evolution.