Extended Endoscopic Approaches in Skull-Base Malignancies Surgery: 8 Years of Experience from a Neurosurgical Reference Center in Chile

Introduction: Malignant tumors affecting the skull base present a significant surgical challenge, despite advancements in imaging and surgical technology. Transnasal endoscopic surgery has become an essential tool for approaching these neoplasms, offering detailed views of anatomical compartments that are otherwise inaccessible to conventional techniques.

Objectives: The primary objective of this study is to describe the efficacy and safety of endoscopic skull base approaches for the diagnosis and/or treatment of skull base malignancies performed at the Instituto de Neurocirugía Dr. Asenjo (INCA) in Santiago, Chile, between 2015 and 2024. Secondary objectives include describing the epidemiological and clinical aspects of the selected patients, characterizing the surgical techniques used, and detailing early complications.

Inclusion Criteria: Patients aged 5 to 80 years who underwent nasal endoscopic surgery for skull base malignant neoplasms, performed by the otorhinolaryngology and/or neurosurgery team at INCA between September 2015 and March 2024, were included.

Exclusion Criteria: Patients with incomplete records were excluded from the study.

Materials and Methods: This retrospective study collected data from the physical and electronic records of the included patients. The information was transferred to an Excel database for descriptive statistical analysis.

Results: The series included 57 patients with skull base malignancies who underwent transnasal endoscopic surgery. The mean age was 47 years, with 56.1% women and 43.8% men. The main clinical manifestations included headache (54.3%), nasal symptoms (45.6%), and visual deficits (36.8%). Malignancies primarily affected the nasal cavity (71.9%) and clivus (40.4%). The most frequent diagnoses were chordoma (31.6%) and olfactory neuroblastoma (14%). Of the surgeries, 66.6% aimed for total resection, using either pure (52.6%) or combined (12.2%) endoscopic techniques. The remaining 33.3% were biopsies. Among the surgeries aimed at total resection, 36.8% achieved complete resection, while 63.2% resulted in partial resection. A multilayer graft was used in 80.7% of skull base repairs. The mean hospital stay was 7.67 days. Postoperative complications occurred in 21% of patients, with the most frequent being epistaxis (8.77%), followed by healthcare-associated infections (5.2%), visual deficits (3.5%), neurological deficits (1.8%), and cerebrospinal fluid fistulas (1.8%).

Conclusion: Endoscopic surgery is an effective approach for skull base malignancies. The results suggest a high rate of tumor excision despite the anatomical difficulties of certain locations, highlighting the versatility and safety of this technique with a low rate of early complications. This study contributes to the understanding and evolution of endoscopic approaches in oncologic neurosurgery, emphasizing their efficacy and applicability in treating skull base neoplasms.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025