By MD S.James Zinreich, Donlin M. Long, John K. Niparko, Bert W. O'Malley Jr, S. James Zinrich, Daniel J. Lee
Operative methods without delay at the base of the mind, internal ear, and cranial nerves are inherently gentle undertakings, and are extra complex via the trouble of attaining quick access to this restricted area. that includes wide diagrams, illustrations, and pictures, this booklet comprehensively covers all the relevant surgical ways to the bottom of the cranium. Written via pioneers operating at one of many world's major facilities for complicated neurosurgery, it sincerely describes the stairs wherein all of the key anatomical constructions on the cranium base and internal ear will be accessed to be able to practice complex surgical interventions.
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Extra resources for Atlas of Skull Base Surgery (The Encyclopedia of Visual Medicine Series)
The circle of Willis, relationships of the base of the brain to the base of the skull, and intracranial nerve anatomy have to be equally well mastered. The skull base surgeon needs to know how to expose the brain and how to use refined drilling techniques to facilitate delicate skull base resections around cranial nerves and important blood vessels. The operating microscope and microneurosurgical instruments must be used effectively The surgical techniques for intraorbital surgery, intracranial surgery, head and neck surgery, and neurootology are all different, but the complete skull base surgeon must borrow the best techniques from each field and practice them in a complementary fashion.
Note the relationships between the important surgical boundaries (see opposite page) Page 23 Page 24 Figure 6 Standard facial and coronal incisions for, anterior craniofacial resection PROCEDURE Anesthesia and patient positioning The patient is placed supine on the operating table, general endotracheal anesthesia is induced, and placement of urinary arterial and central venous catheters is performed as needed. The head is elevated by 10–15° to facilitate venous drainage and can either be fixed with Mayfield pins or supported by a horseshoe head rest.
Large deep-lobe parotid tumors and parapharyngeal space paragangliomas and nerve sheath tumors that extend superiorly to the skull base would be good candidates for a combined facial translocation and mandibular swing approach. Given the broad range of tumor types and the clinical scenario, a thorough understanding of both the tumor histology and the extent of invasion will ensure the appropriate surgical approach and reconstruction, while taking into consideration the need for postoperative adjuvant radiation or chemotherapy.
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