Transcranial endoscope-assisted keyhole surgery: anterior fossa

Objective: The concept and surgical technique of endoscope-assisted keyhole surgery in treating lesions of the anterior fossa and central skull base is described in this article. Methods: Between 2007 and 2011, 362 patients underwent endoscope-assisted keyhole surgery utilizing the supraorbital subfrontal (SOR, n=218), mini-pterional frontotemporal (PTE, n=105), and frontal interhemispheric (FIH, n=39) approaches. A retrospective case note review was carried out in 244 consecutive cases performed by the lead author to extract data on surgical outcome, followed up with a patient satisfaction survey in 210 patients. Results: Six patients died from non-surgical complications in the post-operative period (overall mortality was 2.5%). The 30 day post-operative Glasgow Outcome Scores were as follows: five in 212 patients (86.9%), four in 16 (6.6%), three in six (2.5%), and two in four patients (1.6%). There was no statistically significant difference in post-operative complications comparing the SOR, PTE, and FIH approaches (P>0.05). The overall level of satisfaction was high: postoperative cosmesis was rated as very pleasant or pleasant in 203 out of 210 patients (96.7%), and post-operative wound pain as absent or minimal in 196 out of 210 patients (93.3%). Conclusion: In our study, endoscope-assisted keyhole techniques were associated with excellent surgical outcomes and high patient satisfaction.