• Saad Alsaleh, Abdulrahman Albakr, Saud Alromaih, Abdullah Alatar, Ahmad Salman Alroqi, and Abdulrazag Ajlan.
• From the Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
• Ann Saudi Med. 2020 Mar 1; 40 (2): 94-104.

BackgroundEndoscopic transnasal surgery has gained rapid global acceptance over the last two decades. The growing literature and understanding of anterior skull base endoscopic anatomy, in addition to new dedicated endoscopic instruments and tools, have helped to expand the use of the transnasal route in skull base surgery.ObjectiveReport our early experience in expanded endoscopic transnasal surgery (EETS) and approach to skull base neoplasms.DesignDescriptive, retrospective case series.SettingMajor tertiary care center.Patients And MethodsA retrospective case review was conducted at King Saud University Medical City between December 2014 and August 2019. Cases with skull base neoplasms that underwent EETS were included. EETS was defined as endoscopic surgical exposure that extended beyond the sellar margins (prechiasmatic sulcus superiorly, clival recess inferiorly, cavernous carotid lines laterally). Routine transsphenoidal pituitary neoplasms, neoplasms of sinonasal origin and meningoencephaloceles were excluded.Main Outcome MeasuresPreoperative clinical assessment, imaging results, surgical approach, and hospital course were all retrieved from the patient electronic charts. Clinical follow-up, perioperative complications, and gross residual tumor rates were documented and reviewed.Sample Size And Characteristics45 cases of EETS, 13 males and 32 females with mean age of 39.0 (17.7) years (range 2-70 years).ResultsThe series comprised a wide range of pathologies, including giant pituitary adenoma (8 cases), meningioma (23 cases), craniopharyngioma (4 cases), chordoma (4 cases), optic pathway glioma (2 cases), epidermoid neoplasms (2 cases), astrocytoma (1 case), and teratoma (1 case). For the entire series, gross total resection was achieved in 25/45 operations (55.5%). Postoperative cerebrospinal fluid leak was the most common complication observed in 9 patients (20%) which were all managed endoscopically. Major vascular complications occurred in 2 patients (4.4%) and are described. Other complications are outlined as well. No mortality was observed.ConclusionsEETS to the skull base can be done with results comparable to traditional approaches. More work is needed to expand our experience, improve outcomes, and educate the public and medical community in our region about the usefulness of this approach.LimitationsSample size and study design.Conflict Of InterestNone.

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