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Endoscopic Expanded Transnasal Approach

Last Updated: February 18, 2020

Figure 1: Anatomy of the anterior skull base seen through the transnasal endoscopic route (image courtesy of AL Rhoton, Jr).

Endoscopic transnasal surgery has revolutionized our operative philosophy for many challenging and difficult-to-reach skull base tumors. An understanding of the technical nuances of approach or “how to get there” is important for the skull base neurosurgeon to work as part of the team with the rhinologist to ensure adequate exposure for the tumor is secured. Overall, the transnasal approach remains in the territory of our rhinology colleagues.

I will review the nuances of the technique for the expanded transnasal exposure to the anterior skull base in this section. Suprasellar meningiomas, craniopharyngiomas, and other third ventricular lesions are suitable candidates for this approach.

I prefer to remove moderate size olfactory groove meningiomas (wi...