Endoscopic Endonasal Approach for Rare Skull Base Pathologies: Insights from a Neurosurgical Perspective

Endoscopic endonasal approach (EEA) has become a well-established approachfor skull base pathologies, providing a minimally invasive corridor to accessvarious lesions. While the technique has been extensively studied for commonskull base tumors, data on extremely rare pathologies remain limited. Our studyaims to present our experience with rare skull base lesions managed via theendoscopic endonasal approach, highlighting the challenges associated withpreoperative diagnosis, intraoperative decision-making, and surgical strategymodifications.MethodsA retrospective analysis was conducted on patients who underwent endoscopic endonasal surgery at Bahcesehir University and Kocaeli Universtiy Departmentof Neurosurgery up to December 2024. Among 6,177 endoscopic endonasalprocedures performed, 41 patients with exceptionally rare skull base pathologieswere identified. Each tumor type was separately evaluated for differences inresection rates, complication rates, and recurrence patterns.ResultsThese included 6 pituitary pituicytomas, 5 plasmacytomas, 5 xanthogranulomas, 4 granular cell tumors, 3 giant cell tumors, 2 cases each of germinoma,hemangioma, Langerhans cell histiocytosis, malignant epithelial tumor, andoncocytoma, and 1 case each of aneurysm, bone cyst, angiofibroma, ependymoma, Hodgkin lymphoma, lymphoid hyperplasia, B-cell acute lymphoblasticleukemia, neurinoma, osteosarcoma, and teratoma.ConclusionsEven in highly experienced centers, rare skull base pathologies pose uniquediagnostic and surgical challenges. The discrepancy between preoperative andintraoperative findings often necessitates real-time strategic adaptations. Inthese rare cases, for optimizing patient outcomes requires a comprehensiveunderstanding of skull base anatomy, flexibility in surgical planning, readinessfor sudden strategy modifications, and a multidisciplinary approach.