University of Pittsburgh, Pittsburgh, PA.
University of North Carolina, Chapel Hill, NC.
Int Forum Allergy Rhinol. 2019 Jul;9(S3):S145-S365. doi: 10.1002/alr.22326.
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).
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.
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.
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.
内镜颅底手术（ESBS）用于治疗多种颅底病变。随着 ESBS 的应用日益增多，该领域的文献也迅速增加。然而，由于这些疾病罕见、手术研究固有的挑战以及 ESBS 中持续的学习曲线，文献质量存在很大差异。为了整合和批判性地评价现有文献，颅底外科专家制定了《内镜颅底外科国际共识声明（ICAR:ESBS）》。
使用先前描述的方法，确定了涵盖 ESBS 各个方面的主题，并为每个主题分配了文献综述、循证综述或循证综述加推荐的格式。然后，由神经外科和耳鼻喉科的颅底外科医生撰写并审查每个主题。在经过这个迭代审查过程后，综合了 ICAR:ESBS 文件，并由所有作者进行了共识审查。
ICAR:ESBS 文件讨论了 ESBS 在原发性脑脊液（CSF）鼻漏、硬脑膜内肿瘤、良性颅底和眼眶病变、鼻窦恶性肿瘤和斜坡病变中的作用。此外，还评估了 ESBS 中的特定挑战，包括内镜重建和并发症管理。
对 ESBS 文献的批判性评价表明，在 CSF 鼻漏和垂体腺瘤等病变中，ESBS 的至少与替代方法相当，并且在减少 CSF 漏方面，重建技术得到了改善。在其他病变中，循证推荐有限，这些重大的知识空白呼吁颅底社区抓住这些机会，并共同解决这些不足。
