History of endoscopic skull base surgery: its evolution and current reality

Abstract

The history of the endoscope exemplifies the manner in which technological advances influence medicine and surgery. Endoscopic systems have evolved and improved, and they currently provide detailed visualization of a variety of deep organ structures. Otorhinolaryngological surgeons have used the endoscope for more than 30 years. In the 1990s, a number of influential neurosurgeons and otorhinolaryngological surgeons began performing purely endoscopic pituitary surgery. Endoscopic transsphenoidal operations are now extending beyond the sella. The collaboration between otorhinolaryngologists and neurosurgeons has produced a new subspecialty of "endoscopic skull base surgery." There is a great deal of progress still to be made in developing skills, instruments, and improving skull base repair. The extended skull base approaches allow surgical exposures from the olfactory groove to C-2 and to the infratemporal region and jugular fossa laterally. This article discusses the history of the endoscope, the pivotal technological advances, and the key figures in the burgeoning field of endoneurosurgery.

Real Time Parallel Intraoperative Integration of Endoscopic, Microscopic, and Navigation Images: A Proof of Concept Based on Laboratory Dissections

“…[18][19][20][21][22][23][24][25][26] The main advantage of the microscope is the ability to provide stereoscopic images associated with high degree of maneuverability (by allowing the use of both hands). On the other hand, the endoscope provides a close-up view of the lesion, with capability of looking around the corners and, when angulated lenses are used, of providing a panoramic view of the surrounding area.…”

“…Until now, endoscopic and microscopic techniques have been, by and large, regarded as mutually exclusive, sometimes competitive, techniques. [19][20][21][22][23][24]26 Even when one wanted to combine the microscope and the endoscope in the same setting, there has been a lack of tools to make this combination smooth and effective, 20 mainly due to the fact that when using the endoscope in a microsurgical environment the surgeon has to switch from the microscope ocular view to the endoscope monitor view or vice versa.…”

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

“…This trajectory is particularly appealing in that it allows for tumor resection without the need for brain retraction typically associated with open trans-cranial techniques [ 109 ]. However, it does require the same microsurgical techniques and skill utilized in a trans-cranial approach and poses a significantly higher challenge in terms of skull base reconstruction and the possibility of postoperative CSF leak and meningitis.…”

The historical evolution of transsphenoidal surgery: facilitation by technological advances

“…According to histories by Doglietto et al 13 and Prevedello and colleagues, 50 the first endoscope was invented by Philipp Bozzini in 1806. The "lichtleiter" comprised an eyepiece and a container for a candle, which when lit was reflected by a mirror through a tube.…”