Skull base surgery

Surgical inaccessibility, the obstacles of vital neural and vascular anatomy, and the overwhelming surgical mortality rate as a result of hemorrhage and sepsis have led surgeons to approach lesions of the skull base with understandable reluctance. We have, however, undergone a technical revolution in microsurgery, anesthesia, and neurodiagnosis. Innovative surgical minds have thus been armed with the technology to make surgery a reasonable alternative for these dreaded lesions. This article singles out the glomus tumor and its associated lesions, which the neuro-otologist must approach transtemporally. Their diagnosis and new treatment concepts are discussed. Old criteria for unresectability are redefined and new classifications are established. Surgery of these skull base lesions is discussed from the standpoint of the basic principles of exposure, hemostasis, and management of the facial nerve. Problems in rehabilitation of postoperative deficits are discussed.