Abstract
Recently, an endoscopic trans-nasal approach has become frequently used for skull base surgery. Depending on the extent of the skull base lesions, an appropriate corridor in the nasal cavity should be chosen to avoid excessive resection of important nasal constructions. For the mid-line approach including pituitary surgery, resection of the vomer and anterior wall of the sphenoid sinus provides sufficient surgical fields without resection of the middle turbinate. In some cases, partial resection of the superior turbinate is required. In cases in which surgical procedures around the carotid prominence and the optic nerve canal in the sphenoid sinus, ethmoidectomy via the middle meatus is necessary. In such cases, partial resection of the superior turbinate is required, but the middle turbinate can be preserved. It is also important to understand the anatomical relation between the sphenoid and posterior ethmoid sinus, especially to an Onodi cell, which if present would be located superiorly to the sphenoid sinus. For more advanced cases, maxillectomy is necessary to access to the lateral aspects of the sphenoid. The round canal and vidian canal are two important landmarks in this approach. When the pedicled mucoperiosteal septal flap is elevated for the reconstruction of the skull base, we should pay attention to the location of the olfactory epithelium and septal branches of the sphenopalatine artery.
