• Min Ho Lee, Sang Duk Hong, Kyung In Woo, Yoon-Duck Kim, Jung Won Choi, Ho Jun Seol, Jung-Il Lee, Hyung Jin Shin, Do-Hyun Nam, and Doo-Sik Kong.
• Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
• World Neurosurg. 2019 Feb 1; 122: e1491-e1504.

BackgroundBased on our experience with the endoscopic endonasal approach (EEA) and transorbital approach (TOA) for middle cranial fossa tumors, we evaluated the efficacy and limitations of visualization and the clinical outcomes associated with the approaches depending on the surgical corridors. In addition, we determined the optimal strategy for each approach.MethodsBetween September 2015 and May 2018, we retrospectively reviewed clinical outcomes in 21 patients who underwent minimally invasive endoscopic surgery for middle cranial fossa tumors involving the cavernous sinus. We classified the endoscopic approaches into 4 groups: endonasal quadrangular transcavernous (type I), endonasal infratemporal (type II), transclival medial-to-lateral (type III), and transorbital (type IV) routes. Displacement of the internal carotid artery, extent of tumor involvement, and the surgical corridor to the tumor direction were the primary determinants of the approach.ResultsThe study enrolled 21 patients. Based on the classification of approaches, 6 patients underwent surgery via type I, 5 via type II, 1 via type III, 7 via type IV, and 2 via a combined approach. Among the 21 patients, gross total resection was performed in 12 (57.1%), subtotal resection in 6, and partial resection in 3. Comparison of the type I (EEA) with the type 4 (TOA) route showed that the gross total resection rate with the EEA was 33.3% compared with 71.4% with the TOA (P = 0.286).ConclusionsEndoscopic surgery can be considered an alternative with acceptable sequelae and reduced morbidity for the management of middle cranial fossa tumors. Surgeons should be aware of the strengths and weaknesses of each surgical corridor and select the optimal approach for each patient based on the tumor.Copyright © 2018 Elsevier Inc. All rights reserved.

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