Professor of Rhinology & Skull Base Surgery, Ain Shams University, Cairo, Egypt
Department of Oto-Rhino-Laryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

 
                                                                                        
Skull base Approaches have many difficulties 
due to both anatomic complexity and presence of vital structures. To reach deep 
areas, normal tissues have to be either radically extirpated with subsequent 
reconstruction or mobilized with subsequent reposition and fixation. 
Recent advances in both radiological and visually aided techniques facilitate 
management of such skull base lesions. Endoscopic surgery is superior to 
visually unaided conventional surgery in minimizing the need to mobilize or 
extirpate normal structures and in conserving cranial base anatomy and function. 
The angled panoramic endoscopic view with its unlimited depth of focus is the 
underlining factor in visualizing deep hidden recesses and in realizing anatomy 
at the best. Spatial orientation of anatomy is best with endoscopes and the 
magnification effect can be appreciated by coming closer to the target and also 
by the camera attached to the endoscope. 
Endoscopic surgery alone can excise many benign 
nasal and anterior skull base tumors and tumor-like masses. A small percentage 
of malignant tumors can also be resected with adequate safety margins provided 
that they are early and of limited extensions. Endoscopes when augmented with 
microscope are excellent for excision of pituitary tumors and clival lesions. 
Traditional external approaches when augmented with endoscopes, limits of 
exposure are considerably expanded.