Expanded Endonasal Approach

The Expanded Endonasal Approach (EEA) represents one of the most significant advances in skull base surgery over the past two decades. Developed by Dr. Kassam at the University of Pittsburgh alongside ENT colleagues, the EEA uses the natural nasal corridor to access and remove complex lesions of the skull base and brain, entirely without external incisions.

The technique was defined through sentinel publications outlining the rostrocaudal axis: Part I covering the crista galli to the sella turcica, and Part II covering the posterior clinoids to the foramen magnum. These publications have become among the most cited in the field of skull base surgery.

Before this approach was developed, removing skull base tumors typically required a craniotomy, partial removal of the skull, and retraction of brain tissue to reach the tumor from above. The EEA upends this paradigm, approaching the pathology from below through the natural nasal corridor, eliminating the need for brain retraction in most cases.

Using high-definition endoscopes inserted through the nostrils, surgeons can visualize and access the ventral skull base, from the frontal sinus to the upper cervical spine. The approach eliminates the need for external incisions, brain retraction, or craniotomy in many cases, resulting in reduced surgical trauma, shorter hospital stays, and faster recovery compared to traditional open approaches.