State of the Art in Endocranial Skull Base Surgery: Development of Minimally Invasive Microsurgical and Endoscopic Techniques

The last two decades have noted the emergence of the concept of mini-invasive skull base surgery, defined by a minimization of the surgical opening and tissue trauma while optimizing the oncological objective. Many factors have contributed to this paradigm shift including modern neuroimaging, high definition cameras, accurate neuronavigation and electrophysiologic peroperative monitoring just to cite a few of them. This paradigm shift is justified by the seek for an improvement in the patients’ quality of life. Elsewhere, the complexity of the skull base anatomy totally justifies the need for a multidisciplinarity in the diagnosis as well as the treatment processes (ENT, maxillofacial, neuroradiologist, radiotherapist, radiosurgeon, neurosurgeon…). Dedicated meetings gathering these specialists have been recently set up for the improvement of the patients’ carepath.In a first part we will remind the classical techniques of skull base surgery before enlightening the recent paradigm shift toward mini-invasive techniques as well as the resulting educational requirements.