Approach to diagnosis of skull base lesions

The ability to operate safely on the skull base and yet preserve cranial nerves and leave the patient with minimum neurologic deficit is a fairly new development. The field is expanding rapidly, and lesions that were once deemed unresectable can now be resected. With this in mind, one must maintain an extremely high index of suspicion for lesions in this area. Early diagnosis of skull base lesions is enhanced by a careful neuro-otologic history and physical examination on all patients with complaints of pain, headache, or cranial nerve dysfunction, either motor or sensory. Based on a thorough examination, a tentative lesion localization is made and appropriate special sensory, laboratory, and radiographic tests are used to confirm the abnormality. In addition, it is our responsibility to maintain a knowledge of the state of the art as to treatment possibilities for skull base lesions.