ICAR: endoscopic skull-base surgery.

BACKGROUND: Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). METHODS: Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. RESULTS: The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. CONCLUSION: A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.

The use of an ultraportable universal serial bus endoscope for education and training in neuroendoscopy.

BACKGROUND: Video endoscopy systems are typically very expensive and not particularly portable. We evaluated an inexpensive and ultraportable system for laboratory training in skull base endoscopic dissections. METHODS: In June 2010, we assembled commercially available components consisting of a universal serial bus-powered video camera, a battery-charged light-emitting diode (LED) light source, and a 13-inch laptop to perform skull base endoscopic dissection at our anatomy laboratory. We evaluated its cost, portability, and image quality as a valid tool for neurosurgical and rhinology training. RESULTS: The system performed smoothly with no clinical perception of image delay during video recording. The LED light source and the overall image quality were considered adequate, providing appropriate detail for endoscopic surgical simulation in the laboratory. The cost is around 1/10 to 1/100 of a standard or high-definition endoscopy system, and the entire system weighs only 5 pounds. CONCLUSIONS: The combination of a portable computer's video processing allied to a highly energy-efficient video camera and LED light source is useful for training in neuroendoscopy. Its clinical role in settings with limited resources requires further research.