There are many surgical variants of the endoscopic endonasal approach (EEA), which can be used for management of lesions at the ventral skull base. The main goal of this chapter is to provide the skull base surgeon with strong anatomic…
Preoperative Considerations The far lateral provides wide access to the dorsolateral compartment yet allowing exposure to the lateral aspect of the ventromedial compartment of the posterior fossa (270° visualization of the circumference around the medulla). Variants of the far lateral…
Preoperative Considerations The standard retrosigmoid approach allows for expeditious access to the posterior fossa, specifically to the cerebellopontine angle (CPA). The extended retrosigmoid approach includes the skeletonization of the transverse–sigmoid sinus and an optional partial mastoidectomy to the standard retrosigmoid…
There are a variety of different techniques that can be used to surgically manage anterior skull base lesions. In this chapter we demonstrate the value of the standard and extended subfrontal craniotomies. Indications The subfrontal approach allows access and excellent…
Introduction The supraorbital approach gives access to several areas of the anterior and middle cranial fossa, sellar and parasellar region. It is a minimally invasive alternative to larger approaches such as fronto-orbital, pterional and orbitozygomatic approaches. Two minimally invasive incisions,…
Indications and Contraindications The addition of the orbitozygomatic (OZ) osteotomies to the fronto-temporosphenoidal craniotomy increases the surgeon's workspace and minimizes the brain retraction required to reach deep-seated pathology. The orbital osteotomy allows increased visualization above the anterior clinoids while the…
Indications The pterional craniotomy and the transsylvian approach are the most used techniques in contemporary neurosurgery. The pterional craniotomy allows exposure of the frontoparietal and temporal opercula together with the basal subarachnoid cisterns ( Figure 17.1 ). This approach allows…
Preoperative Considerations Microscopic transcortical or transcallosal approaches may be associated with brain injury and/or retraction that can result in seizures, focal neurologic deficits and cognitive impairment. Endoscopic approaches for the management of intraventricular lesions are intended to be minimally invasive…
Indications Indicated for lesions located within the fourth ventricle or brainstem that extend higher than the pontomedullary junction. The alternative approach has traditionally been the transvermian approach, where the vermis is split. This approach takes advantage of natural corridors without…
Preoperative Considerations The transcallosal approach allows midline exposure of the anterior two-thirds of the third ventricle. Preoperatively, in addition to standard MR imaging, venography is often helpful to assess the pattern of cortical venous drainage in order to help determine…