title: The combined endonasal and transoral approach for the management of skull base and nasopharyngeal pathology: a case series.
abstract: The posterior skull base and the nasopharynx have historically represented technically difficult regions to approach surgically given their central anatomical locations. Through continued improvements in endoscopic instrumentation and technology, the expanded endonasal approach (EEA) has introduced a new array of surgical options in the management of pathology involving these anatomically complex areas. Similarly, the transoral robotic surgical (TORS) approach was introduced as a minimally invasive surgical option to approach tongue base, nasopharyngeal, parapharyngeal, and laryngeal lesions. Although both the EEA and the TORS approach have been extensively described as viable surgical options in managing nasopharyngeal and centrally located head and neck pathology, both endonasal and transoral techniques have inherent limitations. Given these limitations, several institutions have published feasibility studies with the combined EEA and TORS approaches for a variety of skull base and nasopharyngeal pathologies. In this article, the authors present their clinical experience with the combined endonasal and transoral approach through a case series presentation, and discuss advantages and limitations of this approach for surgical management of the middle and posterior skull base and nasopharynx. In addition, a presentation is included of a unique, simultaneous endonasal and transoral dissection of the nasopharynx through an innovative intraoperative setup.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: Satyan B
authors.initials: SB
authors.lastname: Sreenath
authors.forename: Rounak B
authors.initials: RB
authors.lastname: Rawal
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zanation
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery; D002291:Carcinoma, Papillary; D004724:Endoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000601:surgery; D009305:Nasopharynx / Q000601:surgery*; D009666:Nose / Q000601:surgery*; D009668:Nose Diseases / Q000601:surgery; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation; D019291:Skull Base / Q000601:surgery*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery
keywords: CVJ = costovertebral junction; EEA = expanded endonasal approach; ICA = internal carotid artery; TORS = transoral robotic surgery; combined endoscopic transoral approach; endonasal; nasopharynx; robotic; skull base