ICAR: endoscopic skull-base surgery

Eric W. Wang*, Adam M. Zanation, Paul A. Gardner, Theodore H. Schwartz, Jean Anderson Eloy, Nithin D. Adappa, Martin Bettag, Benjamin S. Bleier, Paolo Cappabianca, Ricardo L. Carrau, Roy R. Casiano, Luigi M. Cavallo, Charles S. Ebert, Ivan H. El-Sayed, James J. Evans, Juan C. Fernandez-Miranda, Adam J. Folbe, Sebastien Froelich, Fred Gentili, Richard J. HarveyPeter H. Hwang, John A. Jane, Daniel F. Kelly, David Kennedy, Engelbert Knosp, Devyani Lal, John Y. K. Lee, James K. Liu, Valerie J. Lund, James N. Palmer, Daniel M. Prevedello, Rodney J. Schlosser, Raj Sindwani, C. Arturo Solares, Abtin Tabaee, Charles Teo, Parthasarathy D. Thirumala, Brian D. Thorp, Eduardo de Arnaldo Silva Vellutini, Ian Witterick, Bradford A. Woodworth, Peter-John Wormald, Carl H. Snyderman, Catherine Banks, Matheus Fernandes de Oliveira, Alberto Di Somma, Ahmad Elsawy, Mark S. Ferguson, Hermes G. Garcia, Praveen Hariharan, Reid Hoshide, Edward C. Kuan, Moujahed Labidi, Philippe Lavigne, Marcus Mehlitz, Gautam U. Mehta, Alexander Micko, Sarina K. Mueller, Debraj Mukherjee, Carolyn A. Orgain, Jonathan B. Overdevest, Sheri K. Palejwala, Juan M. Revuelta Barbero, Camilo A. Reyes, Nicholas R. Rowan, Christopher R. Roxbury, Nivedita Sahu, Felipe Sfeir, Dongho Shin, Domenico Solari, Christian Soneru, Madeleine P. Strohl, Peter F. Svider, Rowan Valentine, Kyle Van Koevering, Andrew I. Yang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

194 Citations (Scopus)


Background: Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS). Methods: Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results: The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion: A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.

Original languageEnglish
Pages (from-to)S145-S365
Number of pages221
JournalInternational Forum of Allergy and Rhinology
Issue numberS3
Publication statusPublished - Jul 2019
Externally publishedYes


  • angiofibroma
  • clival chordoma
  • craniopharyngioma
  • CSF rhinorrhea
  • endoscopic endonasal approach
  • endoscopic endonasal skull-base surgery
  • esthesioneuroblastoma
  • evidence-based medicine
  • meningioma
  • nasoseptal flap reconstruction
  • olfactory neuroblastoma
  • pituitary adenoma
  • squamous cell carcinoma


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