Surgical approaches to the brain stem

Abstract

Surgery on the brain stem has been associated with mixed results; aggressive approaches have not always resulted in the best outcomes. The evolution of skull base surgery and a better understanding of anatomy have allowed neurosurgeons to forge new frontiers in surgery on the brain stem. The advances largely reflect improvements in technology, including improved optical techniques, frameless stereotactic systems, dissecting instruments, and advances in radiographic techniques. Magnetic resonance imaging now permits superb delineation of anatomic structures and has improved the accuracy of preoperative differential diagnoses. A more aggressive surgical approach can be planned for discrete lesions. This article reviews some of the most common skull base approaches used at our institution to access the brain stem. Technical pearls are discussed as well as basic steps to the surgical approaches. The advantages and disadvantages of each approach are also detailed.