[Perioperative management of skull base tumor surgery]

In this chapter, vital points in perioperative management of skull base tumor (SBT) surgery are described. Not only surgical techniques and devices but also peri-operative management have been greatly improved in a relatively short period of time, resulting in many additional indications for more complex procedures. Anesthesiologists have therefore assumed more responsibility for the perioperative management of patients. We begin with an introduction of newly developed surgical approaches and a review of major perioperative complications for each approach. Next we describe intraoperative electrophysiological monitoring (IOEM) methods for neuronal protection. Neuronal damage can be caused by maneuvers for obtaining better views of surgical fields, such as compression of juxtaposed tissues and clamping of major arteries. Thus, IOEM should be used for not only structures in the surgical field but also surrounding structures that are exposed to risk of damage. Finally, we describe intraoperative anesthetic management and postoperative intensive care. Some of the methods that were once considered to be neuroprotective have been denied by results of recent studies. Anesthesiologists should therefore update their knowledge of perioperative management for SBT surgery to promote patient safety.