Surgery of extra-axial tumors of the cerebral base

Because of the complex structure of the cranial base and its close proximity to cranial nerves and vessels, surgery in this area is associated with considerable risk of morbidity and mortality. Multiple approaches to each part of the cranial base have been developed over the past few decades, ranging from small modifications of more traditional approaches to complex and sophisticated new techniques. However, experience has shown that optimal outcome is achieved if the selected approach is not associated with significant approach-related morbidity. Furthermore, not all cranial base tumors can be cured by surgery. The selection of operative approach and the goal of surgery should be part of the whole treatment strategy. The attempt to achieve complete resection can, therefore, be justified only if the associated long-term morbidity is minimal. Refinements of the traditional retrosigmoid suboccipital approach have made it the most effective and safe approach, the "gold standard" for lesions in the cerebellopontine angle. On the other hand, in some basal tumors, e.g., chordomas and chondrosarcomas, the approach has to be selected individually and must always be tailored to the characteristics of the particular tumor, its location, and the patient's expectations. The expertise of the surgeon is not reflected in his or her ability to perform the most complex approaches but in the ability to select the approach that affords both removal of the tumor and preservation of patient's neurological function and quality of life.