Limits...
Integrated Anterior, Central, and Posterior Skull Base Unit - A New Perspective.

Brand Y, Waran V, Zulkiflee AB, Lim E, Prepageran N - Front Surg (2015)

Bottom Line: Traditionally, rhinologists are involved in providing access to anterior skull base lesions while otologists are involved in the treatment of lesions of the posterior skull base.This is the case in most skull base centers today.We show how the different skills apply to the different approaches and share our experience with an integrated skull base unit.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, University Malaya Medical Centre , Kuala Lumpur , Malaysia.

ABSTRACT
The skull base is one of the most complex anatomical regions and forms the floor of the cranial cavity. Skull base surgery involves open, microscopic, and endoscopic approaches to the anterior, middle, or posterior cranial fossa. A multispecialty team approach is essential in treating patients with skull base lesions. Traditionally, rhinologists are involved in providing access to anterior skull base lesions while otologists are involved in the treatment of lesions of the posterior skull base. This is the case in most skull base centers today. In this article, we share a new perspective of an integrated skull base unit where a team of otolaryngologists and neurosurgeons treat anterior, middle, and posterior skull base pathologies. The rationale for this approach is that most technical skills required in skull base surgery are interchangeable and apply whether an endoscopic or microscopic approach is used. We show how the different skills apply to the different approaches and share our experience with an integrated skull base unit.

No MeSH data available.


Related in: MedlinePlus

Pre-operative imaging of different skull base pathologies. The first case (A–C) is a 30-year-old male with a clival chordoma. The second case is a 36-year-old male with a recurrent pituitary macroadenoma (D–F). Both these cases were treated with an extended endoscopic endonasal approach. The third case (G–I) is a 52-year-old male with a meningioma in the left cerebellopontine angle. A retrosigmoidal approach was used in this case.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4508483&req=5

Figure 1: Pre-operative imaging of different skull base pathologies. The first case (A–C) is a 30-year-old male with a clival chordoma. The second case is a 36-year-old male with a recurrent pituitary macroadenoma (D–F). Both these cases were treated with an extended endoscopic endonasal approach. The third case (G–I) is a 52-year-old male with a meningioma in the left cerebellopontine angle. A retrosigmoidal approach was used in this case.

Mentions: Today, the team treats a total of approximately 150 skull base cases each year using an integrated team approach. This does not include tumors that are addressed with a craniotomy approach. The majority of cases (approximately 80%) involve extended endonasal endoscopic approaches. As in other centers, the majority of cases involve transsphenoidal resection of pituitary tumors (13). About 20% of the cases involve lateral approaches to the skull base – mostly acoustic schwannomas using a retrolabyrinthine or translabyrinthine approach. Figure 1 illustrates some of the cases treated. During the last 8 years, this integrated approach has proven to be successful in our setting. The caseload allows the same team to manage the cases while also gaining expertise in the field. We found that many of the skills involved in skull base surgery are interchangeable as described above. Most importantly, the morbidity and mortality are in the same range as in well-established centers where separate teams perform extended endoscopic endonasal approaches and lateral skull base surgery (13). Moreover, we have established a hands-on fellowship program where future skull base surgeons are exposed to all the skull base cases and where we emphasize utilization of the interchangeable skillsets.


Integrated Anterior, Central, and Posterior Skull Base Unit - A New Perspective.

Brand Y, Waran V, Zulkiflee AB, Lim E, Prepageran N - Front Surg (2015)

Pre-operative imaging of different skull base pathologies. The first case (A–C) is a 30-year-old male with a clival chordoma. The second case is a 36-year-old male with a recurrent pituitary macroadenoma (D–F). Both these cases were treated with an extended endoscopic endonasal approach. The third case (G–I) is a 52-year-old male with a meningioma in the left cerebellopontine angle. A retrosigmoidal approach was used in this case.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508483&req=5

Figure 1: Pre-operative imaging of different skull base pathologies. The first case (A–C) is a 30-year-old male with a clival chordoma. The second case is a 36-year-old male with a recurrent pituitary macroadenoma (D–F). Both these cases were treated with an extended endoscopic endonasal approach. The third case (G–I) is a 52-year-old male with a meningioma in the left cerebellopontine angle. A retrosigmoidal approach was used in this case.
Mentions: Today, the team treats a total of approximately 150 skull base cases each year using an integrated team approach. This does not include tumors that are addressed with a craniotomy approach. The majority of cases (approximately 80%) involve extended endonasal endoscopic approaches. As in other centers, the majority of cases involve transsphenoidal resection of pituitary tumors (13). About 20% of the cases involve lateral approaches to the skull base – mostly acoustic schwannomas using a retrolabyrinthine or translabyrinthine approach. Figure 1 illustrates some of the cases treated. During the last 8 years, this integrated approach has proven to be successful in our setting. The caseload allows the same team to manage the cases while also gaining expertise in the field. We found that many of the skills involved in skull base surgery are interchangeable as described above. Most importantly, the morbidity and mortality are in the same range as in well-established centers where separate teams perform extended endoscopic endonasal approaches and lateral skull base surgery (13). Moreover, we have established a hands-on fellowship program where future skull base surgeons are exposed to all the skull base cases and where we emphasize utilization of the interchangeable skillsets.

Bottom Line: Traditionally, rhinologists are involved in providing access to anterior skull base lesions while otologists are involved in the treatment of lesions of the posterior skull base.This is the case in most skull base centers today.We show how the different skills apply to the different approaches and share our experience with an integrated skull base unit.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, University Malaya Medical Centre , Kuala Lumpur , Malaysia.

ABSTRACT
The skull base is one of the most complex anatomical regions and forms the floor of the cranial cavity. Skull base surgery involves open, microscopic, and endoscopic approaches to the anterior, middle, or posterior cranial fossa. A multispecialty team approach is essential in treating patients with skull base lesions. Traditionally, rhinologists are involved in providing access to anterior skull base lesions while otologists are involved in the treatment of lesions of the posterior skull base. This is the case in most skull base centers today. In this article, we share a new perspective of an integrated skull base unit where a team of otolaryngologists and neurosurgeons treat anterior, middle, and posterior skull base pathologies. The rationale for this approach is that most technical skills required in skull base surgery are interchangeable and apply whether an endoscopic or microscopic approach is used. We show how the different skills apply to the different approaches and share our experience with an integrated skull base unit.

No MeSH data available.


Related in: MedlinePlus