Skull Base Surgery

Czech version

Authors: M. Sameš ^1–3; P. Vachata ^1–3; A. Zolal ^1–3; T. Radovnický ^1–3; J. Ceé ¹; F. Cihlář ⁴
Authors‘ workplace: Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. Neurochirurgická klinika Univerzity J. E. Purkyně ¹; Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. Anatomická laboratoř baze lební Univerzity J. E. Purkyně ²; Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. Komplexní cerebrovaskulární centrum ³; Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. Radiologické oddělení ⁴
Published in: Cesk Slov Neurol N 2013; 76/109(4): 402-424
Category: Minimonography

Overview

Skull base surgery deals with surgical management of congenital, traumatic, inflammatory, vascular and neoplastic pathologies in the most complex anatomical region of the human body. Extensive development of this subspecialty started in the 1980s and was enabled by the introduction of a surgical microscope, improved microanatomy knowledge (especially topographic relationship of cranial nerves, cerebral vessels and intrapyramidal structures of the temporal bone), developments in neuroimaging (CT, MRI) and advance of neuroanesthesia. However, an intense and systematic interdisciplinary collaboration between neurosurgeons, otorhinolaryngologists and maxillofacial surgeons was the most important prerequisite. In the paper, the large area of the skull base is divided anatomically to the anterior, posterior, middle fossa and the central skull base. The main attention is paid to skull base neoplasms with an emphasis on the initial symptoms and early diagnosis, as this is crucial for surgical treatment. Vascular pathologies, facial nerve reconstruction and pituitary lesions are beyond the scope of this paper. Definition of this field of medicine and its goals has led to the introduction of special anatomical laboratories, international cooperation and systematic education of these technically demanding and time-consuming surgical procedures. Consequently, these procedures ceased to be an exclusive domain of a few most advanced neurosurgeons in the world and the lesions became successfully treated in many countries. The paper also summarizes the development of the global and European skull base societies and a separate chapter is dedicated to the development of this subspecialization in the Czech Republic.

Key words:
skull base surgery – microsurgery – surgical approaches

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