Application of endoscopic transnasal approach combined with microscopic craniotomy in complex skull base tumors with nasal cranial communication

Abstract

Objective To explore the efficacy and safety of endoscopic transnasal approach combined with microscopic craniotomy in the stimultaneous resection of complex skull base tumors with nasal cranial communication, and the protective effect of vascular anastomosis technology in the internal carotid artery (ICA). Methods and Results From January 2020 to December 2022, the Department of Neurosurgery of Tianjin Huanhu Hospital used endoscopic transnasal approach combined with microscopic craniotomy to treat 9 patients with complex skull base tumors with nasal cranial communication at the same time, while 6 patients were protected by identifying, exposing and shifting the ICA during the craniotomy, and 3 patients underwent petrosal segment of the ICA⁃radial artery (RA)⁃bed segment of the ICA bypass on the basis of ICA protection. Among the 9 patients, 8 cases underwent total tumor resection, and one case underwent partial tumor resection; 8 cases [Glasgow Outcome Scale (GOS) level 5] resumed daily life and work at 2 weeks after surgery, one case (GOS level 4) had decreased vision on the affected side but had self⁃ help, and only one case developed intracranial infection 3 d after surgery. Conclusions Endoscopic transnasal approach combined with microscopic craniotomy for simultaneous resection of complex skull base tumors with nasal cranial communication has a definite therapeutic effect and no serious complications, the application of intraoperative ICA protection and vascular anastomosis technology can effectively reduce intraoperative bleeding and postoperative complications.

DOI: 10.3969/j.issn.1672⁃6731.2023.07.002