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This article has been peer reviewed. It is the authors' final version prior to publication in World Neurosurgery. Volume 73, Issue 6, June 2010, Pages 632-633. The published version is available at DOI: 10.1016/j.wneu.2010.05.015. Copyright © Elsevier Inc.


Surgical access to the ventral skull base has evolved considerably over the past several years with the introduction of minimally invasive endoscopic and endoscope-assisted approaches. The accompanying manuscript by Ciporen et al. demonstrates an addition to this growing body of literature in their description of the feasibility of multiportal endoscopic approaches to the skull base, particularly the precaruncular transorbital approach, in a series of cadaver dissections. Similar to laparoscopic abdominal surgery, which utilizes multiple small ports to improve visualization and manipulation, they envision a modular combination of approaches that allows an endoscope to be placed in one port and surgery performed through additional ports. One could imagine such an approach lending itself to the use of the DaVinci robot, which also requires multiple ports of access. However, the utility of the endonasal and transcranial approaches alone or in combination have already been demonstrated (1-9). The novelty of this paper lies in the additional evaluation of the less well-described precaruncular transorbital approach. This approach has been best described by the group in Seattle who also authored the current article

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