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Skull base osseous lesions, including various benign and malignant tumors, and developmental abnormalities like chordomas, osteomas, chondromas, osteosarcomas, fibrous dysplasia (FD), endolymphatic sac tumors, et al, are challenging to treat due to their deep anatomical location near critical nerves and vessels. Surgical treatment demands a balance between complete lesion resection and neural function preservation. In recent years, advances in endoscopy, imaging, intraoperative navigation, proton radiation therapy, and multi⁃disciplinary team (MDT) have led to continuous optimization of treatment strategies for skull base osseous lesions. This paper briefly reviews the current surgical strategies and breakthroughs for skull base osseous lesions.

Objective To investigate the clinical characteristics, neurosurgical strategy and curative effect of intracranial invastive olfactory neuroblastoma. Methods A total of 24 patients with intracranial invasive olfactory neuroblastoma diagnosed and treated in Beijing Tongren Hospital, Capital Medical University from January 2005 to December 2020 were included. All patients underwent bilateral extended transbasal approach combined with endoscopic transnasal approach and skull base reconstruction. Results Among the 24 patients, total resection was performed in 22 cases (91.67%) and nearly total resection in 2 cases (8.33%), all of which were confirmed as olfactory neuroblastoma by postoperative pathological examination. Transient cerebrospinal fluid leakage occurred in 2 cases (8.33%) and intracranial infection occurred in 2 cases (8.33%), which were cured by symptomatic treatment. Visual acuity was aggravated in one case and eye movement disorder in 2 cases. Twenty patients were followed up for an average of 54.60 months, and no long⁃term operation related complications occurred. During the follow⁃up period, 12 patients (60%) had tumor recurrence, and the 5⁃year survival rate was 45% (9/20). Conclusions Surgical resection of intracranial invasive olfactory neuroblastoma via extended transbasal approach combined with endoscopic transnasal approach is safe and effective. The operative surgeon should have both microneurosurgery and neuroendoscopy techniques, which is worthy of clinical promotion.

Objective To explore the experience and technical key points of endoscopic transnasal extreme medial approach for resection of chordoma involving the lower clivus. Methods and Results The clinical data and follow⁃up data of 8 patients with chordoma involving the lower clivus admitted to The First Affiliated Hospital of Zhengzhou University from June 2022 to June 2024 were retrospectively analyzed. All patients underwent endoscopic transnasal extreme medial approach tumor resection and received triple cranial base reconstruction including fascia lata suture sealing + rigid cranial base reconstruction + mucosa flap application. All 8 patients successfully completed the surgery, with a success rate of 8/8. Postoperative 7 d imaging reexamination showed that 6 patients underwent gross total resection of tumor, and 2 patients underwent subtotal resection. At one month after surgery, the headache symptom was relieved in 3 patients (3/4), and nerve dysfunction relief was observed in 4 patients (4/5). The surgical⁃related complications included cerebrospinal fluid rhinorrhea (2 cases) and intracranial drug⁃resistant bacterial infection (one case). One death occurred, and the cause of death was brain herniation secondary to cerebrospinal fluid rhinorrhea and intracranial infection. Two recurrences occurred, and one recurrence was treated with proton radiotherapy + secondary surgical resection, while the other recurrence was treated with secondary surgical resection. Conclusions The endoscopic transnasal extreme medial approach provides a good technical means for gross total resection of chordoma involving the lower clivus. During the operation, adequate exposure of the tumor can be achieved by referring to important bony landmarks, which can effectively resect chordoma involving the lower clivus.

Objective To evaluate the clinical value of the endoscopic expanded endonasal transsphenoidal approach for cerebrospinal fluid rhinorrhea (CSFR) repair in primary hospitals. Methods and Results A retrospective analysis was conducted on 30 patients between January 2022 and December 2023 at Togtoh County Hospital, Jungar Banner People's Hospital, and Siziwang Banner People's Hospital in Inner Mongolia Autonomous Region. All patients underwent endoscopic expanded endonasal transsphenoidal approach for CSFR repair using standardized endoscopic surgical techniques and repair materials (such as autologous fat, fascia, or synthetic materials). All procedures were successfully completed, with an average operative time of (73.00 ± 15.90) min and intraoperative blood loss of (34.00 ± 16.94) ml. The postoperative complication rate was 6.67% (2/30), including transient CSFR (one case) and mild nasal infection (one case), both of which resolved with conservative treatment. The average hospital stay was (7.43 ± 2.06) d. During an average follow⁃up period of (9.97 ± 3.51) months, recurrence occurred in 3 cases (10%), all of which were successfully cured with secondary repair, resulting in a final cure rate of 100% (30/30). Conclusions The endoscopic expanded endonasal transsphenoidal approach for CSFR repair demonstrates favorable efficacy and safety in primary hospitals, along with cost ⁃ saving benefits, making it worthy of wider adoption.

Objective Intraventricular hemorrhage (IVH) of prematurity occurs in 20–38% of infants born < 28 weeks gestational age and 15% of infants born in 28–32 weeks gestational age. Treatment has evolved from conservative management and CSF diversion of temporizing and shunting procedures to include strategies aimed at primarily clearing intraventricular blood products. Neuroendoscopic lavage (NEL) aims to decrease the intraventricular blood burden under the same anesthetic as temporizing CSF diversion measures in cases of hydrocephalus from IVH of prematurity. Given the variety of neuroendoscopes, we sought to review the literature and practical considerations to help guide neuroendoscope selection when planning NEL. Methods We conducted a systematic review of the literature on neuroendoscopic lavage in IVH of prematurity to examine data on the choice of neuroendoscope and outcomes regarding shunt rate. We then collected manufacturer data on neuroendoscopic devices, including inflow and outflow mechanisms, working channel specifications, and tools compatible with the working channel. We paired this information with the advantages and disadvantages reported in the literature and observations from the experiences of pediatric neurosurgeons from several institutions to provide a pragmatic evaluation of international clinical experience with each neuroendoscope in NEL. Results Eight studies were identified; four neuroendoscopes have been used for NEL as reported in the literature. These include the Karl Storz Flexible Neuroendoscope, LOTTA ® system, GAAB system, and Aesculap MINOP ® system. The LOTTA ® and MINOP ® systems were similar in setup and instrument options. Positive neuroendoscope features for NEL include increased degrees of visualization, better visualization with the evolution of light and camera sources, the ability to sterilize with autoclave processes, balanced inflow and outflow mechanisms via separate channels, and a working channel. Neuroendoscope disadvantages for NEL may include special sterilization requirements, large outer diameter, and limitations in working channels. Conclusions A neuroendoscope integrating continuous irrigation, characterized by measured inflow and outflow via separate channels and multiple associated instruments, appears to be the most commonly used technology in the literature. As neuroendoscopes evolve, maximizing clear visualization, adequate inflow, measured outflow, and large enough working channels for paired instrumentation while minimizing the footprint of the outer diameter will be most advantageous when applied for NEL in premature infants.

Background The petroclival area is located deep at the base of the skull, and the surrounding anatomical structure is complex, which brings great challenges to the safe removal of the lesions in this part of the operation. At present, the main surgical approaches for petroclival lesions are lateral craniotomy and endoscopic endonasal approach. This study explored the effectiveness and safety of endoscopic techniques in the resection of petroclival lesions via endonasal approach. Methods A total of 6 patients with petroclival lesions treated in The First Affiliated Hospital of Fujian Medical University from January 2018 to December 2020 were included. All patients underwent neuronavigation assisted endoscopic endosnasal approach resection of petroclival lesions. Results All the 6 patients successfully completed the operation. The average operation time was 4.53 h. After the operation, 3 cases were pathologically confirmed as chondrosarcoma (2 cases of WHO grade 2, one case of WHO grade 1), one case of schwannoma, one case of chordoma and one case of cholesterol granuloma. Except for one case of preoperative double vision that did not relieve postoperatively, the remaining 5 cases had preoperative symptoms alleviated to varying degrees. The average postoperative hospital stay was 5.67 d. The postoperative median follow⁃up was 14.07 months. There were no complications such as cerebrospinal fluid leakage, central nervous system infection, cranial nerve damage, no unplanned secondary operations, and no deaths within 3 months after the operation. Up to the last follow ⁃ up, no patients had recurrence. Conclusions Neuronavigation assisted endoscopic endonasal approach resection of petroclival lesions is relatively safe and effective. Different endoscopic techniques should be selected according to the tumor location and size.

Objective To summarize the key points of neuroendoscopic transcranial resection for cerebellopontine angle (CPA) tumors. Methods Twenty⁃eight patients with CPA tumors diagnosed and treated in Xiangya Hospital Central South University from January 2019 to December 2020 were included, and all of them underwent neuroendoscopic transcranial surgery to remove CPA tumors. Results All the 28 patients were successfully treated with neuroendoscopic transcranial resection of tumors in CPA region, and the tumors were totally removed. After operation, 9 cases of acoustic neuroma, 8 cases of meningioma, 9 cases of cholesteatoma, one case of hemangioblastoma, and one case of trigeminal neurinoma were confirmed by postoperative pathology. Postoperative facial nerve function was grade Ⅲ in 3 cases, grade Ⅱ in 6 cases, and grade Ⅰ in 19 cases. One patient had no obvious recovery of auditory nerve function injury, and 2 patients had dizziness, vertigo and nausea after operation. No complications such as cerebrospinal fluid leakage, meningitis and incision infection occurred, and no death occurred. At 3 months of follow ⁃ up, no tumor recurrence was seen on MRI, and no new neurological symptoms occurred. Conclusions Neuroendoscopic transcranial resection of CPA tumors has many advantages, but also has some shortcomings, and has a good development in the future.

The etiology pattern of pituitary diseases is diverse and complex, including pituitary adenoma, Rathke cleft cyst (RCC), pituitary apoplexy, craniopharyngioma, etc. The pituitary is located in the sellar region of the skull base, so transsphenoidal approach is the first choice for pituitary surgery. With the development of endoscopic technology in neurosurgery, more and more neurosurgeons use endoscopic transsphenoidal surgery to treat pituitary diseases. In this paper, we review the recent literature and to present the value of endoscopy for pituitary diseases.

Objective To investigate the clinical features, diagnosis and surgical treatment of spontaneous cerebrospinal fluid rhinorrhea (CSFR) in the lateral recess of sphenoid sinus. Methods and Results A retrospective analysis was conducted on the clinical data of 24 patients with spontaneous CSFR in the lateral recess of sphenoid sinus admitted to Beijing Tongren Hospital, Capital Medical University, between January 2019 and June 2023. Among them, there were 7 males and 17 females, with an average age of 46 years and an average body mass index (BMI) of 27.24 kg/m2. The average preoperative lumbar puncture (LP) cerebrospinal fluid (CSF) pressure was 200 mm H2O in 21 patients, with 11 patients exhibiting CSF pressure ≥ 200 mm H2O. Imaging studies revealed bone defects and meningoencephalocele herniation into the sphenoid sinus in all 24 patients. All patients underwent transnasal endoscopic repair surgery for CSFR. Specifically, 2 patients with preoperative CSF pressure ≥ 300 mm H2O underwent lumboperitoneal shunt (LPS) first, while the remaining 22 patients underwent endoscopic resection of meningoencephalocele in the lateral recess of sphenoid sinus via the pterygoid process approach, accompanied by skull base leak repair surgery. Two weeks postoperatively, the CSF pressure was reviewed in 21 patients, ranging from 140 to 320 mm H2O, with an average of 185 mm H2O. All patients were followed up for an average duration of 25.40 months. Subsequently, 3 patients with recurrent CSFR underwent LPS, and all 24 patients achieved clinical cure. Conclusions Spontaneous CSFR is related to chronic intracranial hypertension. Transnasal endoscopic leakage repair and CSF shunts are effective methods to treat this disease and prevent recurrence.

Introduction Endoscopy was first employed in the surgical treatment of neurosurgical diseases early in the twentieth century, but did not become an established practice for a long time, mainly because of poor technology and clinical results. After a slow re-appearance in the 1980s, the 1990s saw an explosion of techniques and instrumentation. Continuing technological improvement has led to further expansion of surgical techniques and indications for use of neuroendoscopy. Discussion The expansion of ventricular endoscopy has led to significant understanding of CSF disorders. Aqueduct stenosis as cause of hydrocephalus and arachnoid cysts are an example of pathologies, the concept and understanding of which now is considerably enhanced, due to the application of neuroendoscopy in their treatment. Management of loculated hydrocephalus has been facilitated considerably with the use of the endoscope. The concepts of aqueductoplasty, septostomy, and foraminoplasty of the foramina of Monro and Magendie emerged, which were previously unknown. Skull base surgery, especially surgery for craniopharyngioma, has seen dramatic improvement in results with the use of the endoscope. Coupling of the endoscope with neuronavigation has expanded technical capabilities even further. Overall, we can do a lot more with the endoscope now in comparison to 30 years ago. Conclusion We should always remember that the endoscope is only a tool. Its use has indications and limitations related to its design and our ability to extract the maximum, in the context of its shortcomings. Further technological advances will push surgical frontiers even more in years to come.