Management considerations for malignant tumors of the skull base

The last two decades have brought refinements in diagnostic imaging, instrumentation, and microvascular reconstruction, and an improved overall appreciation of the anatomy of the skull base, both open and endoscopic. These refinements have extended the boundaries of tumor resection and have obviated adjuvant therapies in some patients with benign or low-grade tumors. In patients with high-grade malignancies, however, a carefully constructed multimodal treatment plan, incorporating surgery, radiation therapy, and chemotherapy, is necessary to maximize patients' outcomes.