{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:23Z","timestamp":1787025743985,"version":"build-2736575974"},"reference-count":82,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:p>The posterior skull base and the nasopharynx have historically represented technically difficult regions to approach surgically given their central anatomical locations. Through continued improvements in endoscopic instrumentation and technology, the expanded endonasal approach (EEA) has introduced a new array of surgical options in the management of pathology involving these anatomically complex areas. Similarly, the transoral robotic surgical (TORS) approach was introduced as a minimally invasive surgical option to approach tongue base, nasopharyngeal, parapharyngeal, and laryngeal lesions. Although both the EEA and the TORS approach have been extensively described as viable surgical options in managing nasopharyngeal and centrally located head and neck pathology, both endonasal and transoral techniques have inherent limitations. Given these limitations, several institutions have published feasibility studies with the combined EEA and TORS approaches for a variety of skull base and nasopharyngeal pathologies. In this article, the authors present their clinical experience with the combined endonasal and transoral approach through a case series presentation, and discuss advantages and limitations of this approach for surgical management of the middle and posterior skull base and nasopharynx. In addition, a presentation is included of a unique, simultaneous endonasal and transoral dissection of the nasopharynx through an innovative intraoperative setup.<\/jats:p>","DOI":"10.3171\/2014.7.focus14353","type":"journal-article","created":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T04:43:47Z","timestamp":1412138627000},"page":"E2","source":"Crossref","is-referenced-by-count":18,"title":["The combined endonasal and transoral approach for the management of skull base and nasopharyngeal pathology: a case series"],"prefix":"10.3171","volume":"37","author":[{"given":"Satyan B.","family":"Sreenath","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rounak B.","family":"Rawal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam M.","family":"Zanation","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina"},{"name":"Department of Neurosurgery, University of North Carolina at Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0370002","series-title":"Laryngoscope","first-page":"2081","article-title":"Endoscopic endonasal transpterygoid nasopharyngectomy","volume":"121","author":"Al-Sheibani","year":"2011"},{"key":"b2-0370002","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"751","article-title":"The Le Fort I osteotomy approach for nasopharyngeal and nasal fossa tumors","volume":"114","author":"Belmont","year":"1988"},{"key":"b3-0370002","series-title":"Oper Tech Otolaryngol Head Neck 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experience","volume":"48","author":"Castelnuovo","year":"2010"},{"key":"b8-0370002","series-title":"Otolaryngol Head Neck Surg","first-page":"424","article-title":"Endoscopic endonasal nasopharyngectomy in selected cancers","volume":"149","author":"Castelnuovo","year":"2013"},{"key":"b9-0370002","series-title":"Head Neck","article-title":"Transoral robotic surgery of the parapharyngeal space: A case series and systematic review","author":"Chan","year":"2013"},{"key":"b10-0370002","series-title":"Ear Nose Throat J","first-page":"E1","article-title":"Combined endoscopic and transoral resection of a primary nasopharyngeal paraganglioma","volume":"89","author":"Chu","year":"2010"},{"key":"b11-0370002","series-title":"Eur Arch Otorhinolaryngol","first-page":"235","article-title":"Combined transoral transnasal robotic-assisted nasopharyngectomy: a cadaveric feasibility study","volume":"269","author":"Dallan","year":"2012"},{"key":"b12-0370002","series-title":"J Otolaryngol Head Neck 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transnasal approach in the repair of congenital posterior choanal atresia: clinical experience","volume":"40","author":"Hassan","year":"2011"},{"key":"b17-0370002","series-title":"Int Forum Allergy Rhinol","first-page":"762","article-title":"The utility of a combined endoscopic and transoral resection of maxillary ameloblastoma","volume":"3","author":"Jain","year":"2013"},{"key":"b18-0370002","series-title":"Otolaryngol Head Neck Surg","first-page":"413","article-title":"Facial translocation: a new approach to the cranial base","volume":"103","author":"Janecka","year":"1990"},{"key":"b19-0370002","series-title":"Laryngoscope","first-page":"1575","article-title":"Transoral robotic surgery to resect skull base tumors via transpalatal and lateral pharyngeal approaches","volume":"122","author":"Kim","year":"2012"},{"key":"b20-0370002","series-title":"Curr Opin Urol","first-page":"66","article-title":"Is robotic surgery cost-effective: 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Neck","first-page":"1190","article-title":"Combined transnasal endoscopic and transoral robotic resection of recurrent nasopharyngeal carcinoma","volume":"34","author":"Yin Tsang","year":"2012"},{"key":"b1-0370002","series-title":"Laryngoscope","first-page":"2081","article-title":"Endoscopic endonasal transpterygoid nasopharyngectomy","volume":"121","author":"Al-Sheibani","year":"2011"},{"key":"b2-0370002","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"751","article-title":"The Le Fort I osteotomy approach for nasopharyngeal and nasal fossa tumors","volume":"114","author":"Belmont","year":"1988"},{"key":"b3-0370002","series-title":"Oper Tech Otolaryngol Head Neck Surg","first-page":"26","article-title":"Surgical resection of the nasopharynx","volume":"21","author":"Brown","year":"2010"},{"key":"b4-0370002","series-title":"Int J Med Robot","article-title":"Transoral robotic surgery for pharyngeal stenosis","author":"Byrd","year":"2014"},{"key":"b5-0370002","series-title":"Head Neck","first-page":"E351","article-title":"Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base","volume":"35","author":"Carrau","year":"2013"},{"key":"b6-0370002","series-title":"J Neurooncol","first-page":"337","article-title":"Evolution and advances of the lateral surgical approaches to cranial base neoplasms","volume":"20","author":"Cass","year":"1994"},{"key":"b7-0370002","series-title":"Rhinology","first-page":"84","article-title":"Nasopharyngeal endoscopic resection in the management of selected malignancies: ten-year experience","volume":"48","author":"Castelnuovo","year":"2010"},{"key":"b8-0370002","series-title":"Otolaryngol Head Neck Surg","first-page":"424","article-title":"Endoscopic endonasal nasopharyngectomy in selected 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Almeida","year":"2009"},{"key":"b13-0370002","series-title":"Head Neck","first-page":"848","article-title":"Transoral robotic approach to carcinoma of unknown primary","volume":"36","author":"urmus","year":"2014"},{"key":"b14-0370002","series-title":"J Craniovertebr Junction Spine","first-page":"44","article-title":"Combined transnasal and transoral endoscopic approaches to the craniovertebral junction","volume":"1","author":"El-Sayed","year":"2010"},{"key":"b15-0370002","series-title":"Otolaryngol Clin North Am","first-page":"513","article-title":"The infratemporal fossa approach for the lateral skull base","volume":"17","author":"Fisch","year":"1984"},{"key":"b16-0370002","series-title":"J Otolaryngol Head Neck Surg","first-page":"271","article-title":"Combined transoral transnasal approach in the repair of congenital posterior choanal atresia: clinical experience","volume":"40","author":"Hassan","year":"2011"},{"key":"b17-0370002","series-title":"Int Forum Allergy Rhinol","first-page":"762","article-title":"The utility of a combined endoscopic and transoral resection of maxillary ameloblastoma","volume":"3","author":"Jain","year":"2013"},{"key":"b18-0370002","series-title":"Otolaryngol Head Neck Surg","first-page":"413","article-title":"Facial translocation: a new approach to the cranial base","volume":"103","author":"Janecka","year":"1990"},{"key":"b19-0370002","series-title":"Laryngoscope","first-page":"1575","article-title":"Transoral robotic surgery to resect skull base tumors via transpalatal and lateral pharyngeal approaches","volume":"122","author":"Kim","year":"2012"},{"key":"b20-0370002","series-title":"Curr Opin Urol","first-page":"66","article-title":"Is robotic surgery cost-effective: no","volume":"22","author":"Lotan","year":"2012"},{"key":"b21-0370002","series-title":"Head Neck","first-page":"352","article-title":"Transcervico-mandibulo-palatal approach for surgical salvage of recurrent nasopharyngeal cancer","volume":"18","author":"Morton","year":"1996"},{"key":"b22-0370002","series-title":"Laryngoscope","first-page":"1465","article-title":"Transoral robotic surgery (TORS) for base of tongue neoplasms","volume":"116","author":"O\u2019Malley BW","year":"2006"},{"key":"b23-0370002","series-title":"Braz J Otorhinolaryngol","first-page":"75","article-title":"Comparison between endoscopic and open surgery in 37 patients with nasopharyngeal angiofibroma","volume":"78","author":"Oliveira","year":"2012"},{"key":"b24-0370002","series-title":"Am J Otolaryngol","first-page":"379","article-title":"Transoral robotic surgery for supraglottic squamous cell carcinoma","volume":"33","author":"Olsen","year":"2012"},{"key":"b25-0370002","series-title":"Laryngoscope","first-page":"1613","article-title":"Transoral robotic nasopharyngectomy: a novel approach for nasopharyngeal lesions","volume":"118","author":"Ozer","year":"2008"},{"key":"b26-0370002","series-title":"Ann Otol Rhinol Laryngol","first-page":"73","article-title":"Clinical outcomes of transoral robotic surgery for head and neck tumors","volume":"122","author":"Park","year":"2013"},{"key":"b27-0370002","series-title":"Laryngoscope","first-page":"1201","article-title":"Endoscopic versus traditional approaches for excision of juvenile nasopharyngeal angiofibroma","volume":"115","author":"Pryor","year":"2005"},{"key":"b28-0370002","series-title":"Laryngoscope","first-page":"1818","article-title":"Endoscopic management of benign tumors extending into the infratemporal fossa: a twosurgeon transnasal approach","volume":"115","author":"Robinson","year":"2005"},{"key":"b29-0370002","series-title":"J Endourol","first-page":"871","article-title":"A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive?","volume":"26","author":"Rowe","year":"2012"},{"key":"b30-0370002","series-title":"J 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