Kassam AB, Gardner PA, eds. Endoscopic Approaches to the Skull Base. Karger; 2012; 238 pgs.; $268.
Endoscopic surgery has advanced considerably in the past decade, with many general surgery procedures now being more commonly performed endoscopically than through the so-called “open” technique. The role of endoscopy in the field of neurological surgery has been slower to evolve, primarily because anatomical constraints limit the size of the hardware that can be used, and thus the technology had to advance considerably from what is used in general surgery. In addition, the chief anatomical portal to the brain for endoscopic techniques, the nasal cavity, does not lend itself well to watertight sealing after a procedure. This has proven to be a challenging hurdle for the pioneers of endoscopic skull base surgery, and CSF leak rates after endonasal skull base surgery were initially too high to justify the switch from traditional open approaches.
The Skull Base team of the University of Pittsburgh has been at the forefront of endoscopic surgery. Like other skull base centers, they comprise neurosurgeons and ENT specialists. Two neurosurgical members of this team, Drs. Amin Kassam and Paul Gardner, are the editors of this new book, Endoscopic Approaches to the Skull Base. The chapters are authored by an impressive list that makes up the rest of this team, as well as the group from the University of Virginia, well known for their contributions to surgery of the sella.
The book is relatively brief, divided into chapters according to lesion location. After a few appropriate introductory chapters on principles of endoscopic techniques and transitioning from the microscope to the endoscope, the book progresses through 8 anatomical/pathological targets: sella, pituitary tumors, olfactory groove meningiomas, esthesioneuroblastoma, cavernous sinus, clival lesions, craniocervical junction, and cerebellopontine angle. Additional chapters on cranial base reconstruction, management of complications, and endoscopic-assisted (versus primarily endoscopic) skull base surgery round out the collection. Of particular interest is the final chapter, on navigating the steep learning curve that comes with the technique. There is perhaps no group better positioned to comment on what it takes to become expert and minimize complications in endoscopic skull base surgery than these editors.
The chapters are concise and well written, with numerous technical nuances and pearls scattered throughout. There are often small summaries of the surgical outcomes obtained by the authors, which allow the reader to place the technique into the broader context of outcomes for open techniques. Importantly, the text avoids the common problem of a junior person (most often a resident or fellow) writing the chapters: losing the key nuances, perspective, and emphasis present when the senior author writes the text.
The one area where there would have been room for improvement is in the illustrations. The vast majority of the photographs are black-and-white, and there are very few diagrams or figures. Modern neurosurgical texts are replete with beautiful computer illustrations demonstrating key surgical corridors and anatomy, and the authors’ publications often contained such helpful diagrams. Their absence is obvious.
Overall, however, this is a remarkable contribution by the pioneers in endoscopic surgery. Anyone looking to expand their endoscopic practice from simple endoscopic endonasal pituitary surgery to other complex skull base lesions outside the sella would do well to read this excellent text. The complications go up substantially when one ventures outside the sella, and reading this book goes a long way toward minimizing those complications and flattening the learning curve.
