Endoscopic Skull base Amsterdam (ESA) is a modern initiative of the departments of neurosurgery and otolaryngology of the Academic Medical Centre, Amsterdam, the Netherlands. ESA is dedicated to deliver the highest quality care to patients with skull base pathologies: Uniquely, it combines the expertise of all three Amsterdam academic hospitals (AMC, VU , AvL) and multiple specialities (including endocrinology, paediatric endocrinology, radiology, oncology, radiation oncology, plastic surgery and ophthalmology), with Dr. W. van Furth(neurosurgeon) and Dr. C. Georgalas(ENT surgeon) as its directors.
Central to the management philosophy is the use of advanced endoscopic minimally invasive surgical techniques, when possible, with the aim of minimising morbidity and at the same time, improve outcomes. Other techniques and combinations are used when necessary, with true tailoring of the approach for each individual patient.
The multidisciplinary clinic, with the Otolaryngologist, the Neurosurgeon and the Endocrinologist present, is an ideal setting for discussing with the patient the options available to him/her (watchful waiting, radiotherapy and medical treatment as applicable), the goals of surgery (decompression or complete removal), the expected outcome, including the postoperative recovery period and the risks and potential complications. We explain the role of each surgeon and discuss briefly the technical aspects of the operation including the use of endoscopes, intraoperative navigation and reconstruction. Nasal packing, splints and the harvest of fascia lata (as applicable) are discussed. The expected length of hospital stay (depended on the size of the tumor and endocrinological profile of the patient, 2-3 days in the case of small tumors when no intraoperative CSF leak or pituitary insufficiency is expected) is described. The time needed for the healing of nasal mucosa (typically 2-3 months) and the associated crusting expected during that period is explained. Patients are advised to refrain from stressful activities and blowing their nose for 6 weeks and to use nasal saline sprays for the first 4 weeks and subsequently nasal douching. Finally the postoperative follow up schedule and planned postoperative imaging is outlined.