Common Sense in Skull Base Surgery

Abstract

Approaches to the skull base at different regions have been independently developed by the pioneers of neurosurgery, ENT, and maxillofacial surgery early in the last century. Unfortunately, all these approaches for tumor removal had a high risk of mortality and morbidity. Only after the introduction of CT scan and MRI as well as the operative microscope was it possible to plan and perform more precise surgery in these regions. Unfortunately, the majority of pathological entities is not limited outside or inside of the skull base. Therefore, all intra- and extracranial extended tumors at the skull base need an interdisciplinary strategy and surgical expertise of two different specialties like neuro- and ENT surgery. My personal experience in the field consists of approximately 40 years, over which I have applied all approaches, ranging from the simplest to the most complex. Over the years I have become increasingly convinced that whatever approach is used, it should not be related by itself to any significant approach-related complications or morbidity. With the modifications of some classical approaches, that we introduced, we can safely reach and remove any lesion of the skull base. Preservation of neurological functions and good quality of life should always be the goal and the achievement of complete tumor removal should not be attempted at any price.