What is endonasal endoscopic surgery?

Endonasal endoscopic surgery is a minimally invasive procedure that allows pediatric neurosurgeons to remove skull base tumors through the nose using tools called endoscopes.

These procedures have many names, including nasal endoscopic neurosurgery procedures, nasoendoscopic surgery or transsphenoidal surgery.

A tumor at the base (bottom) of the skull can be reached through the nose. This is because the base of the skull is close to the middle of the face, near the nostrils and above the roof of the mouth.

With a more traditional type of surgery called craniotomy, the surgeon has to access these tumors by going through the top of the skull. This surgery also requires a longer stay in the hospital. Endonasal endoscopic surgery, where surgeons come in through the nostrils, is a much more direct and less invasive procedure.

Watch the video to learn more about endoscopic neurosurgery.

Tumors and lesions that can be removed through the nose using endonasal endoscopic surgery include:

• Chondrosarcoma
• Clival chordomas
• Clival encephaloceles
• Craniopharyngioma
• Germinoma
• Juvenile nasopharyngeal angiofibroma (JNA)
• Meningiomas
• Optic gliomas
• Pontine cavernomas
• Prolactinoma and other pituitary tumors
• Rathke’s cleft cysts
• Skull base atypical teratoid rhabdoid tumors (ATRT)
• Skull base sarcomas

What to expect

At CHOP, at least two and sometimes as many as four surgeons are present for endonasal endoscopic surgery procedures. These surgeons are neurosurgeons (brain surgeons) and otorhinolaryngologists (sometimes called ear-nose-and-throat, ENT, rhinologists, or head-and-neck surgeons).

Your child’s surgeons will use cameras and other instruments attached to endoscopes, which are long, thin plastic tubes.

First, the ENT surgeon inserts an endoscope through one nostril to access the sphenoid sinus, an air cavity between the nose and the skull base. Nasoseptal flaps are raised to prevent leaking of cerebral spina fluid (CSF).

Next, the neurosurgeon inserts another endoscope through the other nostril and drills a small hole through the bone of the skull to access the brain. He removes as much of the tumor as possible, using a small cutting tool and a claw on the end of the endoscope. The ENT surgeon uses a camera on another endoscope so that the neurosurgeon can use two hands to operate and see the tumor and surrounding areas on a screen as he works.

This is a very delicate process that can take hours.

After as much of the tumor as possible is removed, the surgeons take fat and fascia (connective tissues) from the thigh and place it into the sinus at the site where the skull was opened. The nasoseptal flaps cover the fat and fascia, preventing cerebral spinal fluid from leaking out of the opening.

Most patients can go home after two to three days in the hospital.