Skull base tumors are rare, accounting for less than 1% of intracranial tumors. Management options include a conservative approach with serial scans, conventional surgery or radiotherapy/stereotactic radiosurgery. Surgery is difficult because of problems with access, involvement of basal blood vessels/cranial nerves and the potential for post-operative cerebrospinal fluid leakage.
This book contains other chapters that deal specifically with the management of:
• Sellar and parasellar tumors.
• Cerebellopontine angle tumors.
Clearly, these tumors comprise a large number of the cases that a skull base team will see. Readers are therefore referred to other chapters for those specific lesions, and we will deal only with those tumors of the skull base not included in the above.
In the past, the skull base has been a surgical "no-man's land", and the discipline of skull base surgery owes its development to individuals in many disciplines who were prepared to tackle the almost impossible problems confronting them at the time. It began near the turn of the century, with resections of acoustic tumors and approaches to the pituitary. It was not until the pioneering work of Ketcham et al. , whose first report appeared in 1963, that co-ordinated efforts between surgical disciplines produced the first series of skull base procedures.
The modern skull base unit comprises a mul-tidisciplinary team, which will include (as a minimum) a neuroradiologist, neurosurgeon, otolaryngologist, plastic and reconstructive surgeon, neuroanaesthetist and intensive care specialist. Nursing and ancillary staff with an interest in neurosurgical/neurological rehabilitation is also mandatory. No one surgeon can obtain, much less sustain, all the skills required to deal with all lesions in this area. Multi-disciplinary management is the only approach that is likely to lead to improved outcomes for patients with these difficult problems - successful skull base surgery is a team effort!
The surgery involved in skull base tumors is often lengthy. The teamwork helps not only in bringing together expertise from different specialties but also provides an opportunity for intermittent relaxation during a prolonged surgical procedure.
Whatever the make up of the skull base team, the neurosurgeon often assumes a major responsibility for the patients in the postoperative period, as the majority of the major complications are related to the brain and its coverings.
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