# Frontiers of Innovation and Clinical Application in Endoscopic Endonasal Transsphenoidal Surgery

## TL;DR

This paper reviews the evolution and recent innovations in endoscopic endonasal transsphenoidal surgery, highlighting its expanded use and improved precision in treating skull base tumors.

## Contribution

The paper provides an integrated overview of technological and conceptual advances shaping contemporary neuroendoscopic surgery.

## Key findings

- ETSS has evolved into an integrated surgical platform with enhanced visualization and navigation capabilities.
- Clinical evidence supports expanding ETSS to complex skull base pathologies like craniopharyngiomas and meningiomas.
- Recent innovations in reconstruction techniques have improved surgical safety and outcomes.

## Abstract

Background/Objectives: Endoscopic endonasal transsphenoidal surgery (ETSS) has undergone substantial evolution driven by continuous technological innovations and is increasingly established as a minimally invasive and highly precise approach for the treatment of pituitary neuroendocrine tumors (PitNETs) and selected parasellar lesions. The objective of this review is to summarize the historical development of ETSS and to provide an integrated overview of recent advances shaping contemporary neuroendoscopic surgery. Methods: A narrative review of the literature was conducted focusing on key technological and conceptual developments in ETSS, including advances in endoscopic visualization systems, artificial intelligence (AI)-based image analysis, intraoperative navigation, educational support frameworks, and skull base reconstruction techniques. Representative clinical studies and review articles were examined to contextualize current applications and limitations. Results: Recent innovations have expanded the functional capabilities of ETSS beyond pituitary surgery alone. Progress in visualization, navigation, and reconstruction techniques has contributed to improved anatomical understanding, surgical safety, and outcome optimization. Furthermore, accumulating clinical evidence supports the selective extension of ETSS indications to complex midline skull base pathologies, including craniopharyngiomas, meningiomas, and chordomas, while emphasizing the importance of appropriate patient selection. Conclusions: ETSS has evolved from a single operative technique into an integrated surgical platform supported by technological convergence. Ongoing refinement of visualization, digital assistance, and reconstructive strategies is expected to further enhance safety and precision. This review highlights current trends in ETSS and outlines future directions for innovation and clinical application in neuroendoscopic skull base surgery.