Endoscopic Approaches of Anterior Skull Base

The concept of transnasal skull base surgery was credited to the ancient Egyptians, who were experts in using the sphenoethmoidal breach approach in the mummification process. A similar route through the sphenoid sinus has been developed and firstly proposed more than a century ago and was restricted to the treatment of tumors of the pituitary region. The progressive evolution in neuronavigation systems, the anatomical understanding, in addition to wide-angled endoscopes this approach was extended to entire midline skull base, from the crista galli to the odontoid process. In contrast to traditional skull base surgical approaches, the endoscopic endonasal approach offers a direct midline access to the suprasellar, retrosellar, and retroclival spaces. It avoids brain retraction and provides excellent visualization of all structure, and as a result, it offers a lower morbidity and mortality rate when compared to transcranial procedures.