Endonasal endoscopic approaches have revolutionized surgical access to the
sellar region and anterior fossa. These minimally invasive techniques utilize the natural
nasal corridors to reach the target area, avoiding the need for external incisions. The
endoscope provides excellent visualization and magnification, enabling precise surgical
maneuvers. In this chapter, the authors describe the anatomical features for performing
endoscopic endonasal approaches to the Sella and the anterior fossa. These approaches
include the traditional endoscopic transsphenoidal approach to the Sella and extended
endonasal approaches, including trans tuberculum, transplant, and transcribiform
approaches. The most remarkable anatomical landmarks and surgical tenets are
discussed. The anterior fossa houses critical structures like the anterior cranial base and
the olfactory system. These structures can be approached for the resection of tumors,
repair of cerebrospinal fluid leaks, and management of traumatic injuries. Endonasal
endoscopic approaches offer reduced morbidity, shorter hospital stays, and faster
recovery than traditional open approaches. Our clinical series shows that technological
advancements and modern endoscopic surgical techniques further enhance the safety
and efficacy of conventional transnasal methods, making them indispensable tools in
the armamentarium of contemporary skull-base surgeons.
Keywords: Anterior fossa, Cribriform plate, Endonasal endoscopic, Endoscopic skull base surgery, Planum sphenoidale, Pituitary gland, Sellar region, Transsphenoidal, Tuberculum sellae.
