Open and Endoscopic Skull Base Approaches

Surgical approaches to the skull base have been evolving at an incredible rate in the past 30 years. The advent of the endoscope has multiplied the available approaches while reducing morbidity. Otolaryngologists and neurosurgeons performing these operations must stay updated in recent trends and techniques to determine the best options for patients. Twenty years have passed since the adoption of the endoscope in skull base surgery but new techniques are still being introduced on an annual basis. Most notably are the “cross court” techniques utilizing the contralateral transmaxillary (CTM) approach and transorbital neuroendoscopic surgery (TONES). Both approaches allow the surgeon increased angulation and access to lateral structures limited by the endonasal approach. Surgeons must understand the patient factors, pathology, and available resources as well as the armamentarium of approaches to the skull base to offer the best option for individual patients.