title: The expanding role of the endonasal endoscopic approach in pituitary and skull base surgery: A 2014 perspective.
abstract: BACKGROUND
  The past two decades have been the setting for remarkable advancement in endonasal endoscopic neurosurgery. Refinements in camera definition, surgical instrumentation, navigation, and surgical technique, including the dual surgeon team, have facilitated purely endonasal endoscopic approaches to the majority of the midline skull base that were previously difficult to access through the transsphenoidal microscopic approach.
  
  
  METHODS
  This review article looks at many of the articles from 2011 to 2014 citing endonasal endoscopic surgery with regard to approaches and reconstructive techniques, pathologies treated and outcomes, and new technologies under consideration.
  
  
  RESULTS
  Refinements in approach and closure techniques have reduced the risk of cerebrospinal fluid leak and infection. This has allowed surgeons to more aggressively treat a variety of pathologies. Four main pathologies with outcomes after treatment were identified for discussion: pituitary adenomas, craniopharyngiomas, anterior skull base meningiomas, and chordomas. Within all four of these tumor types, articles have demonstrated the efficacy, and in certain cases, the advantages over more traditional microscope-based techniques, of the endonasal endoscopic technique.
  
  
  CONCLUSIONS
  The endonasal endoscopic approach is a necessary tool in the modern skull base surgeon's armamentarium. Its efficacy for treatment of a wide variety of skull base pathologies has been repeatedly demonstrated. In the experienced surgeon's hands, this technique may offer the advantage of greater tumor removal with reduced overall complications over traditional craniotomies for select tumor pathologies centered near the midline skull base.
authors.affiliation: The Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Lobo
authors.affiliation: The Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Heng
authors.affiliation: The Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA.
authors.forename: Garni
authors.initials: G
authors.lastname: Barkhoudarian
authors.affiliation: The Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA ; Department of Otolaryngology, Pacific Eye and Ear Specialists, 11645 Wilshire Blvd, Los Angeles, CA 90025, USA.
authors.forename: Chester F
authors.initials: CF
authors.lastname: Griffiths
authors.affiliation: The Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Providence's Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA 90404, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kelly
keywords: Craniopharyngioma; chordoma; endoscopic endonasal surgery; endoscopic pituitary surgery; endoscopic skull base surgery; tuberculum sella meningioma