The endoscopic endonasal, or transsphenoidal, surgical approach uses the nostrils as a natural surgical corridor. This endonasal route is the preferred method for removing pituitary adenomas and many midline skull base and brain tumours. This approach is also used in treating Rathke’s cleft cysts, along with certain craniopharyngiomas, clival chordomas and midline meningiomas.
The endoscopic endonasal approach has evolved into a safe and effective technique, using high-definition endoscopy (surgical telescope), neuronavigation system (resembling “GPS for the brain”) and carotid artery localisation with doppler ultrasound. Its advantages include a high-resolution, magnified view of the tumour and surrounding important tissues, avoidance of brain retraction, minimal manipulation of the optic nerves, and absence of scalp/facial incisions.
The endonasal approach, however, is not suitable for all midline tumours. In certain patients, an alternative minimally invasive route, such as the transorbital approach, the supraorbital eyebrow craniotomy, or a conventional craniotomy may be more suitable.
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