Minimally Invasive Skull Base Surgery

Classically defined as the art of curing by the hand, hand intended as the organ of the possible, and positive certitude according to Paul Valery, surgery is shifting toward a scientific discipline with a very high technological valence. Neurosurgery in general, and skull base surgery in particular do not stave off this natural evolution. Obviously, technological advances have driven the tremendous progresses in both diagnosis (CT scan, MRI, angiography ) and therapeutic fields (ultrasonic aspiration, radiosurgery). This technological aspect should not hide the humanistic remnant of the modern neurosurgeon, who should propose the less invasive technique in his possession to treat most efficiently his patient, keeping in mind the quality of life above all. The compromise between the invasiveness of the surgical approach to the skull base and the main goal of the surgery has shed light on the recent concept of minimally invasive skull base surgery.This concept has been conspicuously initiated by Axel Perneczky in the late 1980s under the descriptive keyhole neurosurgery, especially through the renowned eyebrow supra-orbital mini-craniotomy and the implementation of endoscope-assisted microneurosurgery. A decade after, Jho and others introduced the endoscopic endonasal approaches to the skull base, with a perpetual development and an exponential rhythm of scientific publications. This recent paradigm shift toward a minimal approach-related iatrogeny coupled with a maximally efficient surgical target is not so clear cut, as pioneering neurosurgeons such as Cushing, Dandy or Dott among others already adopted this philosophy of work, limited by the technology available at that time that did not permit their minimally invasive expectations. This has been possible only with the progresses made in the fields of imaging, surgical instrumentation, illumination technologies (microscope and endoscope), radiosurgery, and neuroanesthesia.

Classically defined as the art of curing by the hand, hand intended as the organ of the possible, and positive certitude according to Paul Valery, surgery is shifting toward a scientific discipline with a very high technological valence. Neurosurgery in general, and skull base surgery in particular do not stave off this natural evolution. Obviously, technological advances have driven the tremendous progresses in both diagnosis (CT scan, MRI, angiography ) and therapeutic fields (ultrasonic aspiration, radiosurgery). This technological aspect should not hide the humanistic remnant of the modern neurosurgeon, who should propose the less invasive technique in his possession to treat most efficiently his patient, keeping in mind the quality of life above all. The compromise between the invasiveness of the surgical approach to the skull base and the main goal of the surgery has shed light on the recent concept of minimally invasive skull base surgery.This concept has been conspicuously initiated by Axel Perneczky in the late 1980s under the descriptive keyhole neurosurgery, especially through the renowned eyebrow supra-orbital mini-craniotomy and the implementation of endoscope-assisted microneurosurgery. A decade after, Jho and others introduced the endoscopic endonasal approaches to the skull base, with a perpetual development and an exponential rhythm of scientific publications. This recent paradigm shift toward a minimal approach-related iatrogeny coupled with a maximally efficient surgical target is not so clear cut, as pioneering neurosurgeons such as Cushing, Dandy or Dott among others already adopted this philosophy of work, limited by the technology available at that time that did not permit their minimally invasive expectations. This has been possible only with the progresses made in the fields of imaging, surgical instrumentation, illumination technologies (microscope and endoscope), radiosurgery, and neuroanesthesia.

To date, more than three thousand brain and skull base tumors, along with various vascular problems, have been treated by using advanced, fully endoscopic, minimally invasive surgical techniques. In this book, Dr. Hrayr K. Shahinian, director of the Skull Base Institute, compiles these techniques. The book is highly specific and amply illustrated. The step-by-step operating room procedures provide a definitive guide to the difficult yet essential art of skull base surgery.

Minimal Access Skull Base Surgery – Open and Endoscopic Assisted Approaches is a highly illustrated guide to a range of approaches in ENT surgery, edited by Kofi Boahene and Alfredo Quiñones-Hinojosa from the John Hopkins Medical Institute, Baltimore, USA. The book focuses on minimal access approaches to skull base compartments using an endoscope, via natural and secondary openings into the head. Comprised of 31 chapters, across seven sections, the book begins with a general introductory section which covers imaging of the skull base, surgical pathology of the skull base and anaesthetic requirements for skull base surgery. Further sections cover approaches to surgery via particular anatomical areas, including transorbital, supraorbital, transnasal, infratemporal fossa, and transoral approaches. The concluding sections cover the management of selected skull base lesions, skull base reconstruction and postoperative management. Minimal Access Skull Base Surgery – Open and Endoscopic Assisted Approaches is enhanced by 428 images and illustrations and an accompanying DVD featuring practical guidance on several procedures. This is an essential resource for neurosurgeons, otolaryngologists, head and neck surgeons, and any health care providers involved in these minimal access procedures. Key Points Comprehensive guide to minimal access procedures in skull base surgery Covers minimal access skull base surgery via nose, mouth, eye socket and infratemporal fossa 428 images and illustrations Instructional DVD for several skull base procedures Edited Kofi Boahene and Alfredo Quiñones-Hinojosa based at John Hopkins Medical Institute, Baltimore, USA

Reviews the role of endoscopic endonasal techniques During the last decade the endoscopic endonasal approach (EEA) to the skull base has become a very powerful method to add to the array of neurosurgical technologies. This volume provides a broad overview of the role of transnasal approaches in a wide spectrum of skull base diseases. It starts with a historical perspective of the evolution from the microscope to the endoscope in endonasal surgery and then explores in depth the principles and techniques of the various methods. Discussed are topics based on anatomical boundaries: pituitary fossa to the suprasellar space to the cavernous sinus, clivus and the anterior cranial fossa. Access to the infratemporal and posterior fossae via both the endoscopic endonasal and the retrosigmoid approaches are reviewed. In addition, the critical topic of reconstruction following 'minimally invasive' skull base surgery and finally the learning curve and complications associated with the applications of these new and exciting approaches are discussed. This volume will provide the latest knowledge to help neurosurgeons, otolaryngologists, head and neck surgeons as well as craniofacial surgeons understand the applications and practice of this important technique.

The first two sections of this text address endoscopic and keyhole surgical procedures for cranial base and deep brain structures. These sections provide a comprehensive, state-of-the art review of this minimally invasive field and will serve as a valuable resource for clinicians, surgeons and researchers with an interest in cranial base surgery. The philosophy, techniques, indications and limitations of endoscopic and keyhole cranial base surgery are covered in detail. This reference includes a discussion of the basic principles of these approaches as well as the preoperative planning, intraoperative pearls, and reconstruction techniques. The thorough descriptions of the practical and technical aspects are accompanied by extensive illustrations, figures and operative images. Extending beyond the technical details of these procedures, this text provides a third section that focuses on a thorough analysis and comparison of the endoscopic, keyhole and traditional open approaches to specific intracranial regions. Utilizing a “target-based” approach, the utility of each surgical technique is evaluated in regard to accessing pathology of the anterior, middle and posterior fossa cranial base as well as the deep central regions of the brain. All chapters are written by experts in their fields and include the most up to date scientific and clinical information. Endoscopic and Keyhole Cranial Base Surgery will be a valuable resource to specialists in optimizing surgical results and improving patient outcomes.

Unique in the field, Intrinsic and Skull Base Tumors presents commonly encountered skull base and intrinsic neoplasm cases with side-by-side, case-by-case comparisons that clearly show how various experts would handle the same case. This inaugural volume in the Neurosurgery: Case Comparison Series offers multiple opinions from international experts in neurosurgery who provide various approaches and management styles for the same case. This format allows for quick and helpful comparisons of different ways to approach a lesion, advantages and disadvantages of each approach, and what each expert is looking for in how they would manage a particular case. Offers 3 to 4 expert opinions on each case in a templated format designed to help you quickly make side-by-side comparisons—an ideal learning tool for both trainees and practicing neurosurgeons for board review and case preparation. Helps you easily grasp different approaches to brain tumor management with different expert approaches to the same case and summaries from the editors on the advantages and disadvantages to each approach. Features a wide variety of management decisions, from preoperative studies to surgical approach, surgical adjuncts, and postoperative care, from experts in the field who specialize in different aspects of neurosurgery. Covers low and high grade gliomas, metastatic brain cancers, meningiomas, sellar and parasellar lesions, skull base lesions, and other brain lesions such as colloid cyst, cavernoma, hemangioblastoma, brain abscess, and more.

The quintessential state-of-the-art atlas on endoscopic approaches to the lateral skull base The endoscope has become a highly effective tool in the arsenal of ear and skull base surgeons. Endoscopic Lateral Skull Base Surgery: Principles, Anatomy, Approaches by endoscopic surgery masters Daniele Marchioni and Livio Presutti, reflects their development of innovative transcanalar approaches to the lateral cranial base using the external auditory canal as a surgical corridor. This unique atlas is designed to teach and clarify current and emerging endoscopic-assisted surgery approaches to the lateral skull base. The common goal of these cutting-edge procedures is to access and treat tumors located in the lateral cranial base via the most minimally-invasive endoscopic approach possible, thereby bypassing delicate cranial nerves, dural, cerebral, and vascular structures. Throughout 14 chapters, an impressive group of skull base surgeons share firsthand insights and expertise in areas vital to endoscopic skull base surgery. Key Features Featuring contributions from the who's who of global experts who continue to innovate by using the endoscope beyond its traditional use in middle ear surgery Opening chapters cover anatomy, microscopic approaches, endoscopic dissection, instrumentation, OR set-up, and radiologic assessments Procedural chapters detail endoscopic approaches including transtemporal combined, retrosigmoid, and transcanalar techniques such as suprageniculate, transpromontorial, and infracochlear Patient cases, clinical applications, and step-by-step guidance enhance understanding of diverse endoscopic approaches High-quality preoperative, intraoperative, and postoperative illustrations are selected from thousands of surgeries performed by the authors This remarkable book provides the most comprehensive and elucidating information written to date on endoscopic approaches to the lateral skull base, making it essential reading for novice and expert surgeons alike.