Modern Indications for Endoscopic Endonasal Surgery

Endoscopic endonasal surgery has become a standard procedure for functional treatment of benign pathologies. Materials and improved surgeon skills have allowed the number of indications for this approach to increase. We describe some of the main pathologies, including malignancies, that can be treated endoscopically, focussing on the orbital and skull base pathologies. The orbital indications discussed here are dacryocystorhinostomy, orbital decompression, and optic nerve decompression. Advantages of endoscopic surgery for aggressive benign tumours such as inverted papilloma and juvenile nasopharyngeal angiofibroma are described. The skull base pathologies detailed are ethmoid adenocarcinoma and esthesioneuroblastoma for the anterior skull base surgery and endoscopic transsphenoidal approach to the sella for pituitary tumour surgery. Evidence of the safety and efficacy of endoscopic surgery is increasing but there is a lack of randomised long-term studies.