Skull Base And Related Structures

Handbook of Skull Base Surgery -- Title Page -- Copyright -- Dedication -- Contents -- Preface -- Structure of the Handbook -- Acknowledgments -- Contributors -- Figures -- Abbreviations -- Section I. History, Principles, and Preoperative Assessment -- Chapter 1. History of Skull Base Anatomy and Its Eponyms -- Chapter 2. Anatomy of the Skull Base and Related Structures: Elements of Surgical Anatomy -- 2.1. Skull Base Anatomy-Anterior and Middle Skull Base -- 2.2. Temporal Bone Anatomy -- 2.3. Topographic Anatomy of the Posterior Skull Base -- 2.4. Meningeal Folds -- 2.5. Veins and Dural Venous Sinuses -- 2.6. Exocranial Surface of the Skull Base -- 2.7. Orbits -- 2.8. Sinonasal Anatomy -- 2.9. Craniovertebral Junction -- 2.10. Elements of Surgical Anatomy -- 2.11. Soft Tissues Relations in the Pterional Region -- 2.12. Classification of Intracranial Arteries -- Chapter 3. Functional Anatomy of the Cranial Nerves -- Chapter 4. Skull Base Embryology -- Chapter 5. Skull Base Imaging -- Chapter 6. Pathology of the Skull Base Tumors -- Chapter 7. Clinical and Neurologic Findings in Skull Base Pathology -- Chapter 8. Otorhinolaryngology and Principles of Neurotology in Skull Base Surgery -- Chapter 9. Endocrinology -- Chapter 10. Neuro-Ophthalmology -- Chapter 11. Principles of Anesthesia in Skull Base Surgery -- Chapter 12. Endovascular Interventions for Skull Base Lesions -- Chapter 13. Hi-Tech Tools in Skull Base Surgery -- Section II. Skull Base Surgery -- Chapter 14. Transcranial Approaches to the Skull Base -- 14.1. Presurgical Considerations Regarding the Approach -- 14.2. Anterior Approaches -- 14.3. Anterolateral Approaches -- 14.4. Lateral and Transtemporal Approaches -- 14.5. Posterolateral Approaches -- 14.6. Posterior Approaches -- Chapter 15. Transfacial/Transmaxillary Approaches to the Skull Base.

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.

In recent years, interest in the management of anterior skull base tumors has been fostered by the introduction and subsequent rapid expansion of indications of transnasal endoscopic techniques. In parallel, extraordinary progress has been made in all the other disciplines which are involved in the complex process of managing anterior skull base tumors, leading to substantial improvements in diagnosis and treatment. The anterior skull base can be involved in a large variety of tumors of a varying nature and histology, which in the majority of cases originate from adjacent anatomic sites. In fact, primary lesions of the anterior skull base mainly include osteoma and other tumors originating from bone and cartilage. Tumors involving the anterior skull base have their origin prevalently in the sinonasal tract, but lesions developing on the intracranial site, such as meningiomas, may also extend caudally to encroach upon this area. All these lesions are rare, which means that the pertinent literature does not include prospective studies or treatment guidelines based on a high level of evidence. In view of the extreme histological variability of lesions involving the anterior skull base, much emphasis has been placed on addressing the different nuances of treatment in relation to histology, especially for malignant tumors. The chapters focusing on surgery provide divergent views on selection criteria for a specific surgical technique, which is the aim of this publication.

As a result of its structure, the skull base forms a borderline between different medi cal and surgical specialties. Nevertheless, the pathology of the skull may involve crossing these boundaries. Consequently, treatment may require a multidisciplinary approach with close cooperation between different specialists, each with his specific knowledge and capabilities. A good example is the cooperation needed in the treat ment of skull base trauma. The Skull Base Study Group was founded some years ago in view of this situa tion. Its purpose is to organize international conferences on topics related to skull base pathology. The first was held in June 1982 and focused on the area of trauma tology. The present volume contains articles written by the highly qualified con tributors to the June 1982 conference, dealing with the anatomical, biomechan ical, and neuroradiological aspects of skull base fractures and their consequences in neurologic and vascular dysfunction and deficits. Many authors from Europe and abroad have contributed to the high standard of this book. I would like to congratulate the Editors on the publication of this volume. It contains many important and interesting aspects of particular value to all medical and surgical specialists working in or on one of either sides of the skull base.

Use today’s latest technology and methods to optimize imaging of complex skull base anatomy. This practical reference offers expert guidance on accurate preoperative lesion localization and the evaluation of its relationship with adjacent neurovascular structures. Features a wealth of information for radiologists and surgeons on current CT and MR imaging as they relate to skull base anatomy. Covers localizing skull base lesions, reaching the appropriate differential diagnosis, and deciding which surgical approach is best. Consolidates today’s available information and guidance in this challenging area into one convenient resource.

The Fruits of Reinvention Surgery related to the human head, its compartment and contents has been reinvented over the past 40 years. A number of instruments, most notably the sophisticated medical imaging device and the operating microscope, have principally fueled this evolution. Along the way, endoscopy and sophisticated navigation capabilities have added to the realization of a unique comprehension of normal and abnormal microanatomy permitting corridors and manipu- tions that allow novel strategies for surgery in these highly vital functional areas. Cappabianca, Califano and Iaconetta have created a detailed and fully modern review of methods and strategies related to complex surgery and therapies associated with this robust reinvention. Technical innovations abound! Distinguished practitioners of these unique developments in the history of surgical - terprise present these amazing technical exercises. The catalog of these approaches, inst- mentation, techniques, strategies and manipulations is inspiring and stands as a testimony to the remarkable progress that we have witnessed in recent decades. The presentation in truly “modern” and represents in many aspects pinnacles of operative achievement. We must ask ourselves, what will be next? Los Angeles, November 2009 Michael L.J. Apuzzo, M.D., Ph.D (hon) Preface We belong to a lucky and happy generation, living during a period of many dramatic, if not revolutionary, technical and technological innovations, such as the digital era, which have changed and improved our routine surgical practice, together with the quality and quantity of life of our patients.

The atlas covers the normal microsurgical anatomy of the central skull base as well as the pathological anatomy of the tumorous and vascular lesions of this region. The book gives a detailed description of the contemporary approaches to the individual pathologies in the central skull base which have evolved in the last 15 years. Complete or partial resection of the tumorous lesions, the exclusion of aneurysms and preservation of the patency of the internal carotid artery are given. A unique source of technical data and statistics that allows careful evaluation of the approaches to the region based on a precise understanding of the underlying anatomy.