In the treatment of neurosurgical diseases, the concept of maximizing the protection of neurological function and maintaining the best quality of life for the patient has been accepted by most people and has gradually taken root in people’s hearts. Under the guidance of this concept, more and more minimally invasive techniques have been gradually applied to the treatment of skull base tumors, and have been continuously improved, enriched and perfected in practice. Traditional skull base surgery utilizes extensive resection of the skull base bone to gain exposure and reduce the pulling and damage to the brain tissue. Since the minimally invasive concept is used in skull base surgery, the way of revealing the lesion along the skull base approach has been retained, while at the same time, some scholars have questioned whether the expanded skull base manipulation really increases the exposure of the lesion, and no longer blindly pursues the excessive resection of the skull base bone, so that the surgical trauma is greatly reduced. In addition, the development and improvement of microscopic neurosurgery, stereotactic radiosurgery, neuroendoscopic technology, and neuronavigation technology have provided more choices and guarantees for the “minimally invasive” treatment of skull base tumors. With the maturity of skull base surgery technology and the improvement of neuroendoscopy, neuronavigation and other auxiliary equipment, the development of surgical approaches for skull base tumors has gradually developed in the direction of minimally invasive and concise. Research on the microanatomy of the skull base and surgical access to the skull base has focused on the reappreciation of the exhaustive anatomical features and functions of normal structures, the expansion of classical surgical access, and the objective evaluation of the need for exposure in complex surgical access. Vilela modified the preauricular inferotemporal-inferotemporal fossa approach proposed by Sekhar to excise lesions involving the cavernous sinus, middle and lower slopes, jugular vein nodes, hypoglossal canal, and anterior aspect of the brainstem while preserving the anatomical integrity of the TMJ, obtaining excellent visualization and reducing surgical trauma and TMJ-related complications. Transsphenoidal and expanded transsphenoidal approach On the basis of traditional transsphenoidal approach, on the one hand, tumor resection can be accomplished in most cases with the assistance of single nostril-pterygoidal sinus approach or nasal endoscopy; on the other hand, an expanded transsphenoidal approach proposed by Kitano has been gradually developed and perfected, which is used for resecting cavernous sinus tumors that can not be resected by the traditional transsphenoidal approach, suprasellar tumors, tumors of the anterior skull base, tumors of the slopes, etc., and it has been favored by many scholars. It has been favored by many scholars. Coudwell reported that 105 cases of saddle region and paraspinal tumors of different natures were resected using different expanded transsphenoidal approaches, including 30 cases of pituitary adenomas involving the cavernous sinus, 27 cases of craniopharyngiomas, 11 cases of saddle node meningiomas, 10 cases of pterygoid sinus mucous cysts, 18 cases of slope chordoma, 4 cases of pterygoid sinus carcinomas, 2 cases of metastatic carcinomas of breasts, and 2 cases of fibrous bone dysplasia, with no surgical deaths, and permanent Neurological complications included 1 case of monocular blindness, 1 case of permanent enuresis, 2 cases of cavernous sinus cerebral nerve palsy, 4 cases of internal carotid artery rupture and hemorrhage, 1 case of hemiplegia caused by ligation of internal carotid artery, and the incidence of cerebrospinal fluid leakage was 6%, and it was thought that expanding the transsphenoidal approach could be an effective alternative to transcranial surgeries for the resection of tumors of the skull base in the midline region from the anterior sieve plate, posteriorly down the lower slopes, and on the sides of the cavernous sinus and the optic nerve canal. Micrographic surgery for skull base tumors Saddle region tumors Pituitary tumors It is currently believed that the treatment of pituitary adenomas is aimed at removing the tumor, relieving the clinical symptoms, protecting the pituitary function, and preventing the recurrence of the tumor. Transsphenoidal microsurgery is a safe and effective treatment for the vast majority (more than 90%) of pituitary adenomas, and is regarded as the first choice of treatment for all pituitary adenomas except prolactin adenomas that are sensitive to dopamine agonists; radiotherapy, stereotactic radiosurgery, and medication play an important role for pituitary adenomas that cannot be cured by surgery. The preferred surgical approach is the direct transnasal-pterygoid approach that does not require separation of the septal mucosa, and radiotherapy is not routinely required for completely resected, clinically cured pituitary adenomas. Shou reported a group of 4050 cases of transsphenoidal surgery for pituitary adenomas completed from 1981 to 2004, and in the last 6 years, the rates of complete resection were: HardyGradeI, 97.3%; HardyGradeII, 95.2%; HardyGradeIII, 90＞4%; HardyGradeIV, 47.4%. Mortini reported 1140 cases of transsphenoidal surgery for pituitary adenomas and found that non-functioning adenomas (NFPAs) were the most common (33.2%) and pituitary macroadenomas accounted for 69.1% of cases, with 20.4% of the macroadenomas invading one or both cavernous sinuses; 762 endocrine adenomas had a high incidence of NFPAs and 69.1% of macroadenomas had a low incidence. The early surgical cure rate of 762 endocrine-active pituitary adenomas was 66.1%, with pituitary microadenomas having a better outcome than pituitary macroadenomas, 78.9% and 55.5%, respectively, and the surgical cure rate of pituitary adenomas invading the cavernous sinus was only 7.4%. We have completed more than 3000 cases of transsphenoidal surgery for pituitary adenomas before 2004, and from April 2004 to June 2005, we have completed a total of 325 cases of transsphenoidal surgery for pituitary adenomas, including 35 cases of pituitary microadenomas, all of which were performed by unilateral naso-sphenoidal surgical approach, which has achieved better therapeutic effect. Craniopharyngiomas Craniopharyngiomas can achieve better therapeutic results after total resection, but if not totally resected or recurred after surgery, the difficulty of re-surgery for total resection increases greatly and the long-term prognosis becomes worse. Depending on the size and growth range of the tumor, the surgical approaches that can be chosen include subfrontal approach, wing point approach, wing point via lateral fissure via endplate approach, interlongitudinal fissure via corpus callosum-transventricular foramen approach, and interlongitudinal fissure via corpus callosum-interforaminal approach, and so on. Although the choice of surgical access depends to some extent on the operator’s personal experience and familiarity with the access, it has become the consensus of many scholars to analyze in detail the origin of the tumor, its direction of growth, and its anatomical relationship with the hypothalamus, pituitary stalk, and saddle-diaphragm as much as possible in the preoperative period, so as to choose the surgical access through the natural gap and to reduce the damage to the normal brain tissues. Steno reported the surgical experience of 76 cases of craniopharyngiomas. For tumors in the suprasellar region outside the third ventricle, the subfrontal transendoparietal approach or the wing point translateral fissure-transendoparietal approach was chosen; for tumors located in both the suprasellar and the third ventricle, the interventricular foramen or the mediastinal fissure-transendoparietal approach was chosen; for tumors located exclusively in the third ventricle, the transventricular foramen was chosen in order to reduce the damage to the hypothalamus and other important structures, and it was considered that the preoperative visualization of the The location of the crossover and the volume of the lateral ventricles help to determine the location of the tricuspid ventricle and the relationship of the craniopharyngioma to the floor of the tricuspid ventricle and the hypothalamus, thus guiding the choice of surgical access and reducing damage to the hypothalamus. For tumors located in the saddle or in the saddle and suprasaddle, transsphenoidal surgery is favored by more and more scholars.Maira reported a group of 92 cases of craniopharyngiomas, of which 57 cases were operated by transsphenoidal surgery, of which 11 cases of intra-saddle and 37 cases of intra-saddle and suprasaddle-type craniopharyngiomas were resected by classical transsphenoidal approach, and 9 cases of the tumors that were growing toward the upper part of saddle nodule were resected by transsphenoidal-anterior saddle approach or transsphenoidal-transsphenoidal diaphragmatic approach, with 63% of the total resection rate. The total tumor resection rate was 63%, cerebrospinal fluid leakage was observed in 10 cases, and the tumor continued to grow in 8 cases after surgery, and it was concluded that transsphenoidal surgery was safe and effective for patients with suitable craniopharyngiomas.Chakrabarti reported the results of 68 cases of transsphenoidal and 18 cases of transcranial craniopharyngiomas with long term followups (more than 5 years), and the total tumor resection rate was 90% in the transsphenoidal group, and the growth continued in 3 out of 7 cases of incompletely resected tumors in the course of followup, and 87% of the patients had a complete resection. In the transsphenoidal group, 11 cases were completely resected, 1 case recurred after surgery, and 3 out of 7 cases of incompletely resected tumors continued to grow during the follow-up; however, the incidence of postoperative growth hormone deficiency, hypothyroidism, and urolithiasis in the transsphenoidal group was higher than that in the transsphenoidal group; therefore, it is considered that the transsphenoidal or expanded transsphenoidal approach to resect the tumor is more effective than the transsphenoidal approach to resect the tumor. or enlarged transsphenoidal approach for resection of intrasaddle or intrasaddle suprasaddle type craniopharyngiomas has a positive outcome with few complications. Saddle node meningiomas Although unilateral or bilateral subfrontal approaches are commonly used for the resection of saddle node meningiomas, Benjamin believes that the wing-point transsylvian fissure approach has additional advantages over the former: it provides not only an additional lateral view via the optic nerve gap, but also a lateral view of the pool of the internal carotid artery; it facilitates the protection of the olfactory nerve; and, after resecting the pterionic crest, it provides the shortest distance to reach the saddle node, which is beneficial for the treatment of the base of the tumor. Al-Mefty, on the other hand, concluded that the supraorbital approach had the shortest distance to reach the lesion; grinding the orbital apex alleviated the pull on the frontal lobe brain tissue and provided adequate visualization of the tumor, bilateral optic nerves, bilateral internal carotid arteries, and pituitary stalks, which was conducive to the management of saddle-diaphragmatic adnexal tumors. Cook reported the use of a naso-pterygoid approach to resect three cases of saddle node meningiomas, in which the suprasellar tumors were removed by resection of the posterior pterygoid plateau bone, and the tumors were completely resected in all three cases, with no cerebrospinal fluid leakage occurring; however, two recurred at 10 months after the operation, suggesting that, in conjunction with intraoperative microDoppler detection and endoscopic assistance, the naso-pterygoid approach can be used for the safe and minimally invasive resection of relatively small, confined-to-the-midline-growth saddle node meningiomas. Laws noted the successful resection of seven saddle node or pterygoid plateau meningiomas using the expanded transsphenoidal approach without recurrence or serious complications, thus maintaining a strong interest in the use of this minimally invasive approach to resection of saddle region meningiomas. Cavernous Sinus Tumors The treatment of cavernous sinus tumors remains challenging despite advances in microneurosurgical techniques.AbdalAziz reported on the surgical management of 38 cavernous sinus meningiomas, emphasizing conservative surgical regimens for better functional outcomes.The authors’ treatment plan was to surgically resect tumors in the lateral cavernous sinus cavity (Modified Hirsch Grade 0-1), and for tumors involving the medial cavernous sinus For tumors involving the medial cavernous sinus cavity (modified Hirsch grade 0-1), follow-up observation or radiosurgery was chosen.The results showed that there were no deaths in this group of cases, with a residual rate of 16%, a recurrence rate of 6% for totally resected tumors, and a re-growth rate of 8% for sub-totally resected tumors, and concluded that surgical treatment should be aimed centrally at improving the patient’s functional outcome.Maruyama prospectively examined the treatment options for 40 cavernous sinus meningiomas, which were confined to the cavernous sinus. Maruyama conducted a prospective study of 40 cases of cavernous sinus meningiomas. For tumors limited to the cavernous sinus and far away from the optic apparatus and the brainstem, simple radiosurgery was performed, and for tumors that were close to or compressed the optic apparatus or the brainstem, with diameters of >3 cm, and growing into multiple cavities outside of the cavernous sinus (the suprasellar, the canopy, the rocky oblique area, the middle cranial fossa, or the orbit), or those with suspected malignancy, a combined micrographic surgery and radiosurgery was performed. The actual control rate of the tumor was 94.1% at 5-month follow-up, and the postoperative cranial neurological symptoms improved in 8 cases (20%), facial sensory abnormalities in 4 cases, abduction palsy in 2 cases, and visual and hearing loss in 1 case. The study concluded that a dedicated collaboration between experienced neurosurgeons and radiosurgeons is beneficial in improving the outcome of cavernous sinus tumors.In his commentary, Sekhar pointed out that a radical surgical protocol should still be adopted for cavernous sinus tumors that recur after radiosurgical treatment. Tumors of the pontine cerebellar horn region Acoustic neuroma With the improvement of microscopic neurosurgical techniques and intraoperative neurophysiological monitoring, the rate of total resection of acoustic neuromas and the preservation of the facial nerve anatomy and function have been achieved with desirable results. For patients with effective preoperative hearing, preservation of hearing is an unquestionable goal for surgeons. Due to the complex relationship between the tumor and the cochlear nerve, the anatomical preservation of the cochlear nerve is still difficult; moreover, even if the cochlear nerve is completely preserved during surgery, postoperative loss of hearing can occur due to cochlear blood supply disorders. The highest anatomical preservation rate of the cochlear nerve reported in the literature is 68%, and the functional preservation rate is 39.5%. Anderson used suboccipital posterior ethmoidal sinus approach, transverse labyrinthine approach or combined approach to resect 71 cases of large acoustic neuromas, and 80% of the postoperative patients had facial nerve function of H-B grade I and II, and he thought that the posterior ethmoidal sinus approach or combined transverse labyrinthine approach was beneficial to the facial nerve preservation of large acoustic neuromas.Day thought that the transverse labyrinthine approach was more effective than the posterior ethmoidal sinus approach, avoiding the damage to the cerebellar hemispheres. Mohr reported 386 patients with acoustic neuromas, of whom 128 (33.2%) were surgically resected by the posterior sigmoid sinus approach with neurophysiological monitoring for preservation of hearing, with a postoperative hearing preservation rate of 24.2%, and concluded that the tumors did not fill the internal auditory canal or diameter.