Endoscopic endonasal surgery for cholesteatomas of the posterior cranial fossa and parasellar region. A challenging pathology for experts.

Endoscopic endonasal surgery (EES) offers a direct ventral corridor to the skull base, potentially enabling maximal resection of extensive cholesteatomas (epidermoid cysts) in the posterior cranial fossa and parasellar region. However, outcomes and complications specific to this approach require detailed analysis. A retrospective review was conducted on 34 patients who underwent EES for cholesteatomas of the posterior fossa and parasellar region at a single center from 2011 to 2025 year. Extent of resection (near-total > 95%, subtotal 90-95%), complications, and neurological outcomes were analyzed. Near-total resection was achieved in 65% of cases and subtotal in 35%. The most frequent complications were postoperative cerebrospinal fluid (CSF) leakage (23.5%) and meningitis (23.5%; 33.3% in patients with intradural extension). Rates were significantly higher than for other skull base tumors. Only visual symptoms showed consistent postoperative improvement. New or worsened cranial nerve deficits occurred in 12% of cases. Arrested hydrocephalus requiring shunting developed in 14.7% of patients. The endoscopic endonasal approach is one of the surgical options for patients with cholesteatomas involving the posterior cranial fossa and the chiasmatic-sellar region. However, it is associated with a notably higher risk of CSF leakage and meningitis compared to EES for other pathologies, attributable to the lesion's adhesive and inflammatory characteristics. Furthermore, significant recovery of preoperative neurological deficits (except visual) is uncommon. These findings underscore that indications for selecting this approach must be strictly justified, taking into account the risk of complications.