Endoscopic endonasal approaches for malignant tumours involving the skull base

The treatment of skull base malignancies has evolved significantly during recent decades, requiring the contribution of multidisciplinary teams. Surgery, which plays a pivotal role, ranges from traditional external procedures to endoscopic endonasal approaches (EEA). Recent reports have demonstrated that EEA is feasible, safe, and able to achieve the radical resection of selected lesions, while minimising the morbidity in patients. At the present time, the major criticisms that are made focus on oncologic outcomes, in view of the limited number of patients studied and the short/intermediate follow-up of larger series, which have grouped together different histologies associated with different prognoses. An extensive review of the pertinent literature is addressed here in order to analyse the endoscopic surgical techniques employed, the evolution of indications and the oncologic outcomes. The promising results that have emerged seem to indicate that EEA, when properly planned and performed by experienced surgeons, has nowadays acquired an accepted role with precise indications in the whole armamentarium available for the treatment of skull base malignancies.