By MD S.James Zinreich, Donlin M. Long, John K. Niparko, Bert W. O'Malley Jr, S. James Zinrich, Daniel J. Lee

Operative techniques without delay at the base of the mind, internal ear, and cranial nerves are inherently smooth undertakings, and are extra complex by way of the trouble of accomplishing easy accessibility to this restricted area. that includes broad diagrams, illustrations, and images, this ebook comprehensively covers all the significant surgical ways to the bottom of the cranium. Written through pioneers operating at one of many world's prime facilities for complex neurosurgery, it essentially describes the stairs through which all of the key anatomical constructions on the cranium base and internal ear could be accessed in an effort to practice complex surgical interventions.

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Extra info for Atlas of Skull Base Surgery (The Encyclopedia of Visual Medicine Series)

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The need for facility with multiple approaches is essential to the treatment of skull base tumors (Figure 2). For example, in making the choice of the appropriate bony incisions, it is our belief that the more straightforward the exposure, the less time is spent on this portion of the procedure for access. There is less chance of a postoperative deformity or dysfunction and less risk to vital neurovascular structures traversing the skull base. More circuitous and complex routes present unnecessary risk and danger.

The welcomed addition of radiation oncology provided yet further management options of adjunctive and primary-radiation delivered via stereotactic techniques. This group of specialists has been organized in what we have termed, since 1980, the ‘center of expertise’ concept. In such an organization, the center focuses around highly specialized, well-defined categories of disease. The center provides for all the patients’ needs for the most comprehensive care for their particular disease. The goal of the center is to provide whatever treatment is best for the individual.

A more detailed discussion of pre-operative imaging and cerebral blood flow studies is included in Chapter 2. Table 1 Regions accessible by the transfacial approach Infratemporal fossa Nasopharynx Pterygopalatine fossa Clivus Cavernous sinus Medial orbit, orbital apex and fissures Anterolateral middle fossa Upper cervical spine Page 33 Figure 1 Tumor arising in the posterior maxillary sinus and invading through the infratemporal fossa to the middle cranial fossa. (a) Anterior view depicting the tumor origin; (b) lateral view showing the invasion into the middle cranial fossa and nearby anatomical structures Page 34 Figure 2 (a) Axial MRI scan depicting a metastatic squamous cell carcinoma of the infratemporal fossa; (b) tumor invasion along the trigeminal nerve into the middle cranial fossa Transfacial surgical resection may be applied to a great variety of tumor histologies.

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