Keys to endoscopic nasosinus surgery

Endoscopic nasosinus surgery is an innovative technique in Neurosurgery. It has meant a revolution in the treatment of pathologies that affect the base of the skull, thanks to the fact that access to them avoids having to perform craniotomies, because the approach is carried out through a natural cavity, which are the nostrils.

The pathologies to which this technique is applied are very diverse, from benign tumor pathology, which causes compressive effect of brain structures such as the visual pathway or the brain stem; to malignant tumors in which the aim is to maximize their resection to implement the benefits of adjuvant oncological therapies. Also within the endocrinological tumor sphere, one of the main indications for this type of technique would be tumors of the pituitary gland.

The surgical technique consists in performing an approach through the nostrils to lesions that are located in the roof of the nostrils, and that can develop in the extradural or intracranial compartment.

It should be noted that the postoperative period is practically painless, only for the patient in the more complex approaches, having to wear a nasal packing for 3 to 5 days, in addition to having to keep moderate rest. Apart from this small handicap, it can be said that patients are not even aware that they have been operated on.

The risks derived from this type of approach are minimized thanks to the excellent visualization of anatomical structures provided by modern endoscopes with high-definition cameras and the support of instruments specifically designed to work through the nasal corridor. With the use of neuronavigators the safety of the surgical technique is implemented.

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We can say that endoscopic surgery is no longer considered today as a complement to traditional surgery, but that it has opened a field in which excisions (extractions) of lesions comparable to those performed with traditional surgery are achieved, using a minimally invasive approach that provides comfort and safety for patients.

Regarding the range of pathologies to which we offer treatment, in addition to what has already been mentioned above, intraventricular lesions susceptible to this minimally invasive procedure stand out within the endoscopic sphere, as well as the support provided by this technique in the maximization of resections of lesions located in poorly accessible and deep areas, such as some posterior fossa-pontocerebellar angle tumors. Implementation that is transferred to pain surgery in trigeminal vascular microdecompression in cases of facial neuralgia and spinal periradicular fibrosis with the use of epiduroscopy.

We extend our experience to the management of spinal degenerative and tumor pathology, with the practice of spinal instrumentation navigated with CT. And finally, endoscopic surgery of cervical and lumbar disc herniation is already being developed.