Endonasal Endoscopic Skull Base Surgery: Update and Future Aspects

Endonasal Endoscopic Skull Base Surgery: Update and Future Aspects
Endonasal endoscopic surgery expanded from extra- to intracranial and extra- to intradural procedures, and from surgery of the anterior and middle to surgery of the poste¬rior fossa. The Pittsburgh group and others performed pro¬gressive, innovative, and spectacular operations, and dealt with complications such as a high rate of cerebrospinal fluid (CSF) fistulas. Intensive and honest discussion c1arified the need to improve the methodology of performing duraplasties. In addition to a great variety of proven techniques for dura¬plasty using free autogenic and preserved allografts, Hadad and Bassagasteguy= (Fig. 48.18) introduced a large pedicled septal mucosal flap that was brought up to close dural defects after extended c1ivus surgery. Carrau and many other groups helped to reduce considerably the number of CSF leaks even after major operations. It was recognized that the three parts of a major tumor operation-exposure, resection, and reconstruction-need to be of the highest possible quality.
Whereas at the beginning of interdisciplinary endonasal endoscopic surgery of the brain, skull base, and spine the range of indications was perhaps too great, now the trend is to allow only well-established indications. Amin Kassam re¬cently stated, "Don't cross intradurally vital neural and vas¬cular structures." It will take time to balance the indications for endonasal endoscopic extra- and intradural surgery with well-established c1assic microsurgical procedures with re¬gard to the time needed, the frequency of complications, and the availability of appropriate surgical facilities. There is no doubt that endoscopic surgery has led to a remarkable wid¬ening of the armamentarium in skull base surgery, and the patient benefits from the reduction of surgical side effects.

Category:

Science & Technology

Tags:

• dr. gustavo hadad
• gustavo hadad
• hadad
• dr. luis bassagaisteguy
• base de cráneo
• base de craneo
• skull base
• cirugía endoscópica
• cirugia endoscopica
• endoscopic surgery
• nasoseptal flap
• colgajo nasoseptal
• colgajo hadad-bassagaisteguy
• hadad-bassagaisteguy flap
• fístulas
• líquido cefalorraquídeo
• lcr
• morbilidad.mortalidad
• mejor sobrevida
• rosario
• santa fe
• argentina
• tumores base de craneo

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