Careful planning, consideration of the aims of the surgery, detailed review of the radiology and an in-depth discussion with the patient and family are mandatory before any skull base approach is undertaken. The aim is to help, but this is invariably high-risk surgery and it is vital that the patient and the family understand what is being undertaken and why.
The surgical exposure of skull base lesions commonly involves extensive bone work. Exposure must be adequate and yet not excessive. Adequate exposure reduces the operating distance of deep lesions from the surgeon, reduces the need for brain retraction and provides space for manoeuvring. An adequately planned incision should take into account any previously existing incisions, the vascularity of the flap, cosmetic appearances and the course of the facial nerve. The exposure should also take into consideration proximal and distal control of major vessels. We would utilize electrophysiologic monitoring of the facial nerve in any case where its function could be compromised.
As in every other branch of surgery, there are a vast number of surgical approaches described for different areas of the skull base. We are limited to describing a small number of procedures and will therefore describe only techniques we have used and found "practical".
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