Extended endonasal approach (EEA) in skull base surgery
The extended endonasal approach (EEA) makes it easier for neurosurgeons operating physicians to initially diagnose lesions of the base of the skull in a patient and helps to avoid most of the complications of open access during diagnosis and treatment if an accurate diagnosis could not be made before the operation. Endoscopic biopsy is performed with minimal risk of complications and allows an accurate diagnosis and treatment plan, especially for injuries for which another treatment is preferable (plasmacytoma, lymphoma, infection, etc.) or for which surgical treatment is considered very expensive. We use the EEA method to treat numerous neoplastic and non-neoplastic diseases of the brain structures and the base of the skull. The release of cerebrospinal fluid (traumatic, iatrogenic, or spontaneous) is, in our experience, one of the most common non-neoplastic diagnoses (in addition to inflammatory diseases of the paranasal sinuses). Pituitary adenomas, meningiomas, craniopharyngiomas, and fibro-bone tumors are considered common benign neoplasms in patients.
Chordomas, esthesioneuroblastomas, and paranasal carcinoma with skull base lesions are common malignant neoplasms that are treated with the EEA method. Endoscopic surgical techniques are now the standard in the treatment of benign extradural neoplasms with leakage of cerebrospinal fluid (liquorrhea) and are considered the preferred surgical method in most hospital centers. There is only a limited amount of data that documents the role of these methods in the treatment of malignant tumors of the paranasal cavities with spread to the base of the skull and intradural (benign or malignant) tumors. Even if the first results are very promising, more data and relevant observations from numerous hospital centers are needed before any conclusions can be drawn. The indications and limits of the method (EEA), as well as the operating methods as such, will increasingly spread based on new data and advanced technologies.