This document discusses endoscopic skull base surgery and its advantages over traditional open skull surgery. It is presented by Dr. G. Sundhar Krishnan and Dr. P. Kanthamani of Krishna Eye and ENT Hospitals in Chennai. Endoscopic skull base surgery uses the nasal passages and other natural openings to access the skull base instead of external incisions or craniotomy. It provides better visualization with endoscopes and has benefits like smaller incisions, shorter hospital stays, lower morbidity rates, and better cosmetic outcomes for patients compared to traditional open skull base surgery. The document outlines the indications for endoscopic skull base surgery and provides examples of conditions it can treat as well as case studies with pre- and post

1. ENDOSCOPIC SKULL BASE
SURGERIES

2. Dr. G. SUNDHAR KRISHNAN
M.S., DLO.,
PhD-Endoscopic Skull Base Surgeon
Medical Director
Krishna Eye and ENT hospitals

3. Dr. P. KANTHAMANI
M.D., Ophthal (AIIMS)
Cataract and LASIK
surgeon,
Neuro-ophthalmologist
Krishna Eye and ENT
hospitals,
T Nagar, Chennai

4. ENDOSCOPIC SKULL BASE SURGERY
 Evolving specialty of inexpressible benefitS to patients
 Awareness needs to be created amongst medical
fraternity as well as the public about the indications
 Has revolutionised head and neck surgery.
 It is expanding the horizons of ENT to new frontiers -
Neurosurgery & Ophthalmology

5. DISADVANTAGES OF OPEN SKULL SURGERY /
CRANIOTOMY
• Till recently, these diseases were a problem for both surgeon as
well as patients due to long operating hours, prolonged
hospital stay, unhappy post operative results with compromise
on cosmesis & morbidity.
• Conventional methods involve lot of bone removal & high risk
of multiple cranial nerve palsy which increases the morbidity.

6. To
 Skull Base –anterior,
middle & posterior
 Orbit /Lacrimal sac
 Optic nerve & Optic
Canal
Nose Is the Gateway

7. WHY ENDOSCOPIC APPROACH FOR
THE PATIENT?
 Patient comfortable - minimally invasive,
 Less morbidity
 Scarless –endo nasal or endo oral
 No tonsuring
 No craniotomy
 Quick rehabilitation
 Less expenditure
 Recurrence can be tackled too in a simple way

9. Endoscopic Skull Base OT

10. NO PROPTOSIS. DICHARGED IN ONE DAY
12 YEARS FOLLOW UP- PATIENT FINE, MARRIED & GRATEFUL
Before After
ORBITAL SCHWANNOMA

11. REMOVAL OF SINUS TUMOUR BY
CONVENTIONAL METHOD

12. EXCISION OF MAXILLARY SINUS TUMOUR WITH
EXTENSION TO EYEBALL BY ENDOSCOPIC
METHOD
PRE OPERATIVE POST OPERATIVE

13. SUPRASELLAR DERMOID

14. INDICATIONS
• Pituitary adenoma
• Clival tumours
• CSF leak – rhinorrhoea / otorhinorrhoea
• Parapharyngeal space lesions
• Optic Nerve compression due to traumatic optic neuropathy, papilloedema,
craniosynostosis, fibrous dysplasia, etc
• Proptosis due to medial orbital pathologies like invasive fungal sinusitis, orbital tumours,
Graves ophthalmopathy, etc.
• Medial and inferior orbital wall fractures & foreign bodies
• Cerebello pontine angle tumours
• Juvenile nasopharyngeal angiofibroma with intracranial extension
• Sinonasal neoplasms with extension
• Pterygopalatine fossa/ Infratemporal fossa lesions

15. TO SUMMARISE
BENEFITS OF ENDOSCOPIC SKULL BASE
SURGERY [NATURAL HOLE SURGERY]
 Natural passages like the nose / ear / mouth are mostly used.
Craniotomy is not needed in a majority of them[ burr hole ]
 There is no external scar, hence aesthetically appealing.
 The results are assured because of better visualization with the nasal
endoscope.
 Hospitalization is for a single day or two, unlike two weeks for
craniotomy.
 Morbidity is minimal.
 Mortality is near nil. There is lower rate of recurrence because of the
view provided by angled endoscopes.
 Revision is always possible and easy because of the ready passage
available.

16. THANK YOU
Chennai.
A presentation from