Beyond the Sphenoid Sinus

Endonasal endoscopic surgery, which was originally developed to treating sinus conditions, has allowed us to reach deeper and deeper into the intracranial and intradural structures without demolishing the facial skeleton. Nowadays, this endoscopy enables visualisation of the entire ventral skull base, from the crista galli to the odontoid process [12, 15, 28, 31]. The sphenoid sinus is an important anatomical gateway for surgery on those intracranial structures that would otherwise be accessed traditionally by destructive transcranial or transfacial approaches. The development of neuroendoscopy, which has attracted much attention in recent years because of the great possibilities it offers, is linked with the improvement in surgical skills using four-hands endonasal techniques and with the improvement in appropriately designed surgical instruments. These new tools are: rigid optics with angled vision, double-angled instruments and powered instruments such as intranasal drills, shavers, lavage systems, surgical Doppler probes and neuronavigation. © 2009 Springer Berlin Heidelberg.