Access to the skull base: modular facial disassembly.

Area of Science:

• Neurosurgery
• Surgical Anatomy
• Skull Base Surgery

Background:

• Access to the skull base is crucial for treating various pathologies.
• Existing classifications of skull base access, based on facial skeleton modules, were described by Grime et al. in 1991.
• These classifications do not adequately consider the vertical plane, limiting surgical planning.

Purpose of the Study:

• To enhance the existing classification of skull base surgical access.
• To incorporate the vertical plane into the assessment of surgical approaches.
• To develop a decision-making algorithm for selecting preferred surgical access routes to skull base lesions.

Main Methods:

• Review and analysis of existing skull base surgical access classifications.
• Integration of the vertical plane into the target zone concept.
• Development of a novel decision-making algorithm based on lesion location and surgical access considerations.

Main Results:

• A refined classification system for skull base surgical access is proposed.
• The vertical plane is identified as a critical, previously underutilized dimension for surgical planning.
• A comprehensive algorithm guides the selection of optimal surgical approaches for diverse skull base lesions.

Conclusions:

• The proposed enhanced classification and decision-making algorithm improve the precision of skull base surgical access.
• Considering the vertical plane offers a more comprehensive approach to surgical planning.
• This framework aids surgeons in selecting the most effective and targeted surgical routes for skull base pathologies.