Advances in endoscopic sinonasal and anterior skull base surgery.

Endoscopic transnasal surgery is rapidly replacing more radical external 'open' procedures. At Groote Schuur Hospital, Cape Town, we performed 94 advanced endoscopic sinonasal and anterior skull base procedures over a 2-year period. Most of these would previously have been performed using large external incisions requiring more invasive surgery with significantly higher morbidity. Endoscopic surgery is more cost-effective than open procedures because it reduces duration of hospitalisation, operating time and theatre consumables and obviates the need for postoperative intensive care unit admission. We have had no complications other than 2 cerebrospinal fluid leaks, but the potential risks of endoscopic sinonasal and skull base surgery are significant and proper training is required.