Our endoscopic skull base research brings together surgical access, reconstruction, tumour biology and recovery. The Sydney program includes pituitary and anterior skull base disease, with a particular interest in how multidisciplinary decisions and careful endonasal technique influence the patient’s outcome.
Professor Richard Harvey and the group work across the interface between rhinology, neurosurgery and endocrinology. The research follows the whole course of care: understanding the lesion, planning access, restoring the skull base barrier and assessing nasal function and tumour behaviour over time.
Multidisciplinary care as part of treatment
Pituitary disease brings together hormone function, vision, imaging, pathology and operative decisions. Our research has evaluated the contribution of a dedicated multidisciplinary team to surgical outcomes.
Grayson and colleagues studied 279 patients treated in the five years before and after introduction of a pituitary multidisciplinary team. The later cohort had fewer transient disturbances of water balance and less new hypothyroidism. Median hospital stay was five days compared with seven days, and residual tumour within the sella was less frequent. These findings support the group’s emphasis on coordinated decision-making and perioperative care. [1]
Plan reconstruction alongside the approach
Endonasal surgery uses the nasal corridor to reach the skull base. When surgery opens the protective covering around the brain, reconstruction restores the separation between the intracranial space and the nose. The reconstructive plan is therefore part of designing the operation.
Harvey, Parmar, Sacks and Zanation’s systematic review examined 609 patients with large dural defects across 38 studies. Vascularised reconstruction, using tissue with a retained blood supply, was associated with a lower cerebrospinal fluid leak rate than free graft reconstruction. The review helped establish the evidence supporting vascularised tissue for substantial skull base defects. [2]
Preserve smell and sinonasal function
The nasal corridor has an important function of its own. Our work examines how exposure and reconstruction can be achieved while preserving smell and supporting recovery of the nasal lining.
The group’s 2015 study described preservation of the olfactory strip, the smell-bearing mucosa along the upper septum, during endoscopic pituitary surgery. A modified nasoseptal flap retained reconstructive options while preserving olfactory and sinonasal function. This work places attention on the detail of flap design and mucosal handling. [3]
A subsequent study of 372 patients compared a modified nasoseptal flap with no flap in pituitary surgery where an intraoperative cerebrospinal fluid leak was suspected or evident. The modified-flap group had better sinonasal symptom scores and fewer sinus infections, with similar skull base complication outcomes. The findings extend the group’s work on combining effective reconstruction with preservation of nasal function. [4]
Understand tumour behaviour over time
Pituitary research also asks which features help anticipate recurrence and the need for further treatment. Long-term follow-up connects the operative result with imaging, endocrine assessment and tissue findings.
Lenders and colleagues studied 386 patients from St Vincent’s and Oxford, with a median follow-up of 90 months. Tumour invasion, increased mitotic activity and incomplete resection were associated with recurrence. Ki67 and mitotic count, which describe aspects of cell proliferation, also contributed to identifying aggressive behaviour. This collaborative work supports interpreting pathology together with the clinical and radiological course. [5]
Connect research with surgical education
The common thread is the relationship between technique and outcome: the access required for treatment, the reconstruction that supports healing and the function patients retain afterwards. Our research program and publications brings these studies together with the group’s work in inflammatory disease and nasal breathing.
Explore our research and academic leadership, the Sydney observer program and the one-year clinical fellowship for routes into the group’s educational work.
Selected publications
1. Grayson JW, et al. Multidisciplinary Team Care in the Surgical Management of Pituitary Adenoma. J Neurol Surg B Skull Base. 2021;82:295–302.
2. Harvey RJ, Parmar P, Sacks R, Zanation AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope. 2012;122:452–459.
3. Harvey RJ, et al. The Olfactory Strip and Its Preservation in Endoscopic Pituitary Surgery Maintains Smell and Sinonasal Function. J Neurol Surg B Skull Base. 2015;76:464–470.
4. Khoo AL, et al. Sinonasal and Skull Base Morbidity from a Modified Nasoseptal Flap versus No Flap in Pituitary Surgery. Published online 2025. doi:10.1055/a-2717-2780.
5. Lenders NF, et al. Predictors of pituitary tumour behaviour: an analysis from long-term follow-up in 2 tertiary centres. Eur J Endocrinol. 2023;189:106–114.