Skip to Main Content

++

Although in widespread use, the term “skull base surgery” is somewhat of a misnomer. Only a minority of such procedures are undertaken to expose lesions actually located primarily within the skull base. Most procedures are conducted to expose deep-seated intracranial lesions situated either adjacent to the brainstem (eg, midbrain, pons, or medulla) or beneath the cerebral cortex. Previously, many such tumors were approached via simple openings in the calvaria, which require vigorous and often injurious degrees of brain retraction.

++

The fundamental principle in transbasal craniotomy is removal of the skull base bone to minimize the need for brain retraction. Although current techniques represent a major enhancement in our ability to control inaccessible tumors while minimizing morbidity, they are not panaceas. For example, experience has shown that these procedures are far more suitable for benign lesions (eg, meningiomas, schwannomas, and paragangliomas) and even for low-grade malignant growths (eg, chordomas and chondrosarcomas) than for high-grade malignant lesions (eg, squamous cell carcinoma, adenocystic carcinoma, and soft tissue sarcomas). Currently, more emphasis is placed on the preservation of function, especially cranial nerves, than on the necessity for radical resection in every case. The value of neurophysiologic nerve monitoring for motor nerves within the surgical field has become well established. In the developmental years of skull-base surgery, two-stage procedures were common. More recently, single-stage procedures have become preferred in most centers, even for tumors with sizable intra- and extracranial components, as well as those involving multiple cranial fossae. Computerized imaging modalities provide localizing information that guides the surgeon around vital structures and helps to enable thorough tumor removal.

Jackler RK. Atlas of Skull Base Surgery and Neurotology. Theime, 2009

++

Temporal Bone

++

Temporal bone resection is a fairly radical operation conducted for malignant disease, particularly squamous cell carcinoma originating in the external auditory canal. Some other indications include adenomatous tumors, such as the aggressive papillary adenocarcinoma of the endolymphatic sac and those arising in salivary tissue (eg, adenocystic carcinoma). In most cases, the lateral portion of the temporal bone housing the ear canal is removed en bloc (Figure 66–1). The posterior margin consists of the dural lining of the petrous pyramid, which is exposed via mastoidectomy. The anterior margin often includes some or all of the parotid gland and, at times, the mandibular condyle and the temporomandibular joint (Figure 66–2).

++
Figure 66–1.
Graphic Jump Location

The degrees of temporal bone resection. The solid lines demarcate the so-called sleeve resection of the soft tissue of the canal. This is an insufficient approach to malignant tumors of the region. The dotted lines depict subtotal temporal bone resection. The dashed lines illustrate total temporal bone resection. (Reprinted with permission of Jackler RK.)

++
Figure 66–2.
Graphic Jump Location

Temporal bone resection with a specimen, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.