Controversies: Extended Endoscopic vs. Open Transcranial Approaches. Extended Endoscopic vs. Open Transcranial Approaches.

Endoscopic endonasal skull base surgery approaches for resecting craniopharyngiomas have expanded to include pathological conditions that would have not been contemplated through a transsphenoidal route a few years ago. Early results from many case series seem to confirm the safety and efficacy of endoscopic surgery and extended endoscopic surgery. Meanwhile, the continued use of the microscopic transsphenoidal technique with the assistance of the endoscope remains a viable method for addressing ventral midline craniopharyngiomas. Endoscopy may one day become the gold standard for addressing midline craniopharyngiomas, but this will require improvements in technique and instrumentation as well as dedication on the part of skull base trainees to become acquainted with the endoscope and develop their skills early in their careers. Although the transcranial approach is becoming less popular for the resection of craniopharyngiomas, it will always have a role to play in tackling larger lesions with lateral extensions, and recurrent lesions previously resected via the transsphenoidal route.