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When were cranial base surgery techniques developed?
Cranial base surgery is a relatively recent innovation. High-resolution imaging, such as CT and MRI imaging, provides the surgeon with precise anatomical details that enable rational planning of these procedures.
By precisely mapping the tumors location and its relationships to surrounding brain, nerves, and bony landmarks, it is now possible to design a rational approach for tumor removal.
What technologies are used in cranial base surgery?
Cranial base surgery is a technologically intensive endeavor. High-powered microscopes with fiberoptic illumination are essential, as are high powered drills (with diamond burrs) to safely navigate the cranial base bone which is crisscrossed by vital structures and a virtual forest of important nerves.
Cranial Nerve Monitoring
Cranial nerve monitoring allows a neurophysiologist to identify structures and track the health of various nerves on a computer system. This knowledge allows the surgeon to gently microdissect the tumor from the nerve and optimize neural preservation.
Cranial base surgery is highly dependent on high tech imaging of the tumor and surrounding tissues. For example, image guidance allows CT and/or MRI images of the tumor to be projected for the surgeon's use in the operating room.
Using a "magic wand" whose position is localized in 3D space, the system can identify any position inside the patient's head in reference to the location of the tumor and surrounding vital structures.
Is surgery the only solution for skull base tumors?
Not all skull base tumors require intervention. Some tumors grow so slowly that they pose only a minor risk of more serious problems, especially to older individuals. In such cases, the tumor may simply be monitored by periodic imaging studies.
In addition, high-technology radiation therapy is often an acceptable alternative and is at times preferable to microsurgery in selected cranial base tumors. Typically the CyberKnife is the best option for radiation of skull base tumors
How do patients do following skull base surgery?
Until recently, many deep seated tumors located in the vicinity of the brainstem or beneath the cerebral cortex were either entirely inoperable, or could be exposed only through injurious degrees of brain retraction.
Historically, all approaches to tumors inside the head began by temporarily removing a window in the plate-like skull surface. For tumors located deeply within this often meant pulling or pushing important parts of the brain out of the way. This could result in brain injury affecting movement, feeling, speech, mental abilities, and other adverse neurological consequences.
Modern microsurgical skull base approaches have greatly improved patient results, including in tumor control, patient survival, and numerous important quality-of-life measures.
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