<p><span>This text is designed to function as a comprehensive guide/companion that will not only facilitate the decision-making process for the surgeon, but also help young surgeons build a successful career in skull base surgery. It is divided into six main sections:</span></p><p><span>Â The first s
Contemporary Skull Base Surgery: A Comprehensive Guide to Functional Preservation
â Scribed by A. Samy Youssef (editor)
- Publisher
- Springer
- Year
- 2022
- Tongue
- English
- Leaves
- 800
- Category
- Library
No coin nor oath required. For personal study only.
⌠Synopsis
This text is designed to function as a comprehensive guide/companion that will not only facilitate the decision-making process for the surgeon, but also help young surgeons build a successful career in skull base surgery. It is divided into six main sections:
The first section details the general principles that every skull base surgeon needs to be acquainted with - skull base anatomy, developing a multidisciplinary skull base team, operating room equipment, surgical instruments, and modern imaging technologies. These are the key elements that play a major role in optimizing functional outcomes and patientsâ quality of life. Following this, the compartmental anatomy chapters set the stage for understanding the technical and surgical nuances of each location.
The subsequent five sections are organized as anatomical compartments or regions of the skull base. Every region is organized in the same format for uniformity and ease of use. Each section includes the available treatment choices to each compartment, and describes the relevant pathologies. The contribution of worldwide leaders including neurosurgeons and otolaryngologists provides top-level expertise in how to tackle each pathology.
The surgical approaches chapters that lead each anatomical section describe operative techniques in a clear. stepwise fashion with accompanying intra-operative photos and surgical videos. In the individual pathology chapters, different pathological subtypes are described with representative radiographic images of clinical case examples. Accompanying each pathology is a treatment algorithm based on tumor morphology, pre-operative clinical status, and the goal of maximum functional preservation with a brief description of surgical approaches. This will serve as a roadmap that will help the reader to easily reach a decision of how to treat each skull base pathology.
The general theme is functional and anatomical preservation of key neurovascular structures. Setting such structures as a target and planning an approach that minimizes iatrogenic damage to these structures will lead the surgeon down the road of either open, endoscopic, or a combination of both approaches.
A comprehensive book that is versatile to serve as a handbook as well as a detailed reference for skull base surgery does not currently exist. In addition, combining the two main surgical schools represented by endoscopy and open surgery into one reference enhanced by treatment algorithms is another unique feature.
⌠Table of Contents
Foreword
Preface
How to Use This Book
How to Use This Book: Example Case
Contents
Contributors
Part I: General Principles
1: Evolution of the Multidisciplinary Skull Base Team
History
Establishing the Multidisciplinary Skull Base Team
In the Operating Room
Multidisciplinary Clinics
Regular Multidisciplinary Skull Base Meetings
Future Perspectives
Conclusion
References
2: Surgical Anatomy of the Cranial Nerves
Introduction
History
Cranial Nerve Segments
Olfactory Nerve (I)
Optic Nerve (II)
Oculomotor Nerve (III)
Trochlear Nerve (IV)
Trigeminal Nerve (V)
Abducens Nerve (VI)
Facial Nerve (VII)
Cochleovestibular Nerve (VIII)
Glossopharyngeal Nerve (IX)
Vagus Nerve (X)
Accessory Nerve (XI)
Hypoglossal Nerve (XII)
Cranial Nerve Preservation
Conclusion
References
3: Skull Base Compartmental Anatomy: Microsurgical and Endoscopic
Introduction
Anterior Fossa
Boundaries and Contents
Surgical Considerations
Middle Cranial Fossa and Sella
Boundaries and Contents
Surgical Considerations
Orbit
Boundaries and Contents
Surgical Considerations
Sella
Surgical Considerations
Infratemporal Fossa
Boundaries and Contents
Surgical Considerations
Posterior Cranial Fossa
Boundaries and Contents
Surgical Considerations
Jugular Fossa
Boundaries and Contents
Surgical Considerations
Conclusion
References
4: The Operating Room
The Operative Checklist
The Skull Base Crew
Operating Room Setup
Surgeonâs Position
Surgical Equipment
Conclusion
References
5: Surgical Positioning
Introduction
Concepts in Surgical Positioning
The Rule of Five
Component 1: The Patientâs Head
Component 2: The Body
Component 3: The Surgeon
Component 4: The Personnel in the Room
Component 5: The Equipment
Modeling the Rule of Five Through Case Examples
Pre-sigmoid Approach
Endonasal Endoscopic Approach
Summary
References
6: Cranial Nerve Functional Preservation: Tricks of the Trade
Introduction
Basic Microsurgical Principles of Functional Preservation
Cranial Nerves by Anatomic Region
Anterior Cranial Fossa
Olfactory Apparatus
Optic Nerve
Middle Cranial Fossa
Oculomotor, Trochlear, Trigeminal, and Abducens Nerves
Posterior Cranial Fossa
Facial and Vestibulocochlear Nerves
Lower Cranial Nerves: Glossopharyngeal, Vagus, Accessory, and Hypoglossal
Conclusion
References
7: Neurophysiologic Monitoring
Introduction
Basic Requirements for Intraoperative Monitoring
Cranial Nerve Monitoring
Olfactory Nerve (I)
Olfactory Evoked Potentials (OEPs)
Optic Nerve (II)
Visual Evoked Potentials (VEPs)
Oculomotor, Trochlear, Trigeminal, and Abducens Nerves (III, IV, V, and VI)
Electromyogram (EMG)
Electrooculogram (EOG)
Facial Nerve (VII)
Electromyogram (EMG)
Facial Motor Evoked Potential (FMEP)
Vestibulocochlear Nerve (VIII)
Brain Stem Auditory Evoked Potentials (BAEPs)
Cochlear Nerve Action Potential (CNAP)
Electrocochleography (ECOG)
Lower Cranial Nerves (IXâXII)
Electromyogram (EMG)
Long Tracts
Somatosensory Evoked Potentials (SSEPs)
Motor Evoked Potentials (MEPs)
Medical Management to Enhance Functional Preservation
Conclusion
References
8: Microdissection Tools
Introduction
A Comprehensive Microdissectors Set
Microscissors
Conclusion
References
9: Neuroimaging Precision Tools and Augmented Reality
Introduction
Preoperative Visualization
Computed Tomography
Computed Tomography Angiography (CTA)
Computed Tomography Venography (CTV)
Magnetic Resonance Imaging
MRI Field Strength
MRI Sequences
Conventional or Morphological Sequences
Vascular Sequences
Advanced Sequences
Multiplanar Reformatting and Postprocessing
Digital Subtraction Angiography
DSA and DiagnosticsâArteries
DSA and DiagnosticsâVeins
DSA and TherapeuticsâEmbolization
DSA and TherapeuticsâICA Stenting
Intraoperative Visualization
Neuronavigation
Augmented Reality
AR in Skull Base Surgery
Fluorescence
Fluorescence for Visualization of Surgical Anatomy
Fluorescence for Visualization of Tumor
Conclusion
References
10: Skull Base Reconstruction
Introduction
Reconstruction Principles
Physiological Parameters
âWatertightâ Closure
Dural Onlays
Pedicled Grafts
Reconstruction Adjuncts
Postoperative Management
Skull-Base Reconstruction Paradigms
Anterior Cranial Fossa
Middle Cranial Fossa
Posterior Cranial Fossa
Functional Perspective
Conclusion
References
11: Role of Radiotherapy in Modern Skull Base Surgery
Introduction
History
Gamma Knife Radiosurgery (GKRS) and Single-Dose Radiosurgery (SRS)
Tumor Control
Neurological Function Preservation
GKRS in Combined Micro- and Radiosurgical Treatment for Meningiomas
GKRS for Schwannoma
Tumor Control
Neurological Function Preservation
GKRS for Other Skull Base Tumors
Linear Accelerator Therapies
Fractionated Radiation (FRT), Intensity Modulated Radiotherapy (IMRT), and Stereotactic Radiation (CyberKnife)
Curative Intent
Adjuvant Treatment
Hadron Therapy
Boron Neutron Capture Therapy (BNCT)
Radiopeptide Therapy for Meningiomas
Brachytherapy
Conclusion
References
12: Cerebral Revascularization for Skull Base Lesions
Background and History
Indications for Revascularization
Evaluation for Revascularization
Universal Approach
Selective Approach
Choice of Bypass Strategy
Low Capacitance Bypass
High Capacitance Bypass
Choice of Donor Graft
Donors
Operative Technique
Pre-anastomosis
Anastomosis
Post-anastomosis
Handling the Skull Base Lesion
Case Examples
Conclusion
References
13: Cranial Nerve Repair and Rehabilitation
Introduction
Management of Cranial Nerve Injuries
Olfactory Nerve
Optic Nerve
Extraocular Nerves
Trigeminal Nerve
Facial Nerve
Vestibulocochlear Nerve
Glossopharyngeal, Vagus, and Hypoglossal Nerves
Accessory Nerve
Management of Facial Nerve Injury
Assessment of Iatrogenic Facial Nerve Injury
Early Assessment of Iatrogenic Facial Paralysis
Delayed Assessment of Facial Paralysis
Grading Systems
Electrodiagnostic Studies
Facial Synkinesis
Facial Nerve Repair
Direct Coaptation Versus Interposition Grafting
Nerve Grafting/Nerve Transfer
Dynamic Reanimation for Irreversible Facial Paralysis
Free Muscle Transfer
Regional Muscle Transfer
Static Procedures for Functional Deficit and Asymmetry
Brow
Eye
Upper Lid
Lower Lid
Midface and Lower-Face Tone
Rehabilitation of Facial Nerve Injury
Conclusion
References
Part II: Anterior Cranial Fossa
14: Anterior Fossa Pathology: Open Surgical Approaches
Introduction
Surgical Approaches: The Spectrum
Supraorbital (Fronto-orbital) Approach: Technique
Supraorbital Approach: Example of Applications
Tuberculum Sellae Meningiomas
Specific Surgical Principles
Cranio-orbitozygomatic Approach: Technique
Cranio-orbitozygomatic Approach: Example of Applications
Craniopharyngioma
Specific Surgical Principles
Bifrontal Variants with Interhemispheric Access: Technique
Bifrontal Approaches: Example of Applications
Conclusion
References
15: Endoscopic Endonasal Approaches
Introduction
Transtuberculum and Transplanum Approach
Indications and Limitations
Surgical Technique
Patient Positioning
Nasal Preparation and Approach
Bone Removal
Dural Opening
Intradural Phase
Skull Base Reconstruction
Complication Avoidance
Transcribriform Approach
Indications and Limitations
Surgical Technique
Patient Positioning
Nasal Preparation and Approach
Bone Removal
Dural Opening
Intradural Phase
Skull Base Reconstruction
Complication Avoidance
Conclusion
References
16: Anterior Fossa: Eyebrow Keyhole Approach
Introduction
IndicationâPatient Selection
Preoperative Evaluation of the Patient
Patient Positioning and OR Setup
Supraorbital Approach (Video 16.1)
Postoperative Care
Management and Avoidance of Complications
Conclusion
References
17: Meningioma
Anterior Midline Meningiomas
Evaluation of Olfactory Function
Management Algorithm (Fig. 17.3)
Surgical Approaches
Planum Sphenoidale Meningioma
Tuberculum Sellae Meningioma
Postoperative Care
Anterolateral Meningiomas
Sphenoid Wing Meningiomas
Middle and Lateral Meningiomas
Surgical Approaches
Medial/Anterior Clinoidal Meningiomas
Surgical Approaches
Conclusion
References
18: Craniopharyngioma
Introduction
History
Epidemiology
Pathophysiology
Diagnosis
Surgical Treatment and Radiotherapy
Surgical Compartments
Inferomedial/Sellar Compartment
Superomedial/Suprasellar Compartment
Lateral/Sylvian Compartment
Posterior/Interpeduncular Compartment
Intraventricular Compartment
Surgical Approaches
Expanded Endoscopic Endonasal Approach
Pterional, Pretemporal, and Orbitozygomatic Approach
Supraorbital Keyhole
Transcallosal and Transcortical Approaches
Postoperative Management
Pituitary Dysfunction
Visual Impairment
Hypothalamic Dysfunction
CSF Leak
Quality of Life
Adult Versus Pediatric Patients
Recurrent Disease
Conclusion
References
19: Pituitary Adenoma
Introduction
Classification
Nomenclature
Immunohistochemistry and Transcription Factor Classification
Preoperative Imaging
Preoperative Considerations
Endocrine Considerations
Neuro-ophthalmology
Pituitary Specific Transcription Factor 1 (PIT1) Lineage
Lactotroph Adenomas
Somatotroph Adenomas
Thyrotroph Adenomas
Pituitary Cell Restricted Factor (TPIT) Lineage
Corticotroph Adenomas
Splicing Transcription Factor 1 (SF1) Lineage
Gonadotroph Adenomas and Nonfunctional Adenomas (NFAs)
Silent Corticotroph Adenoma (SCA)
Surgical Nuances and Technique
Positioning and Equipment
Transnasal Approach to the Sella (Fig. 19.5)
Closure
Management of Cavernous Sinus Invasion
Postoperative Considerations
Radiosurgery
Chemotherapy
Conclusion
References
20: Sinonasal Cancer
Introduction
Epidemiology and Clinical Presentation
Diagnosis and Work-Up
Physical Exam
Imaging: CT and MRI
Tissue Diagnosis and Staging
Management
Endoscopic Endonasal Resection
Open Approach: Anterior Craniofacial Resection
Radiation for Sinonasal Malignancy
Chemotherapy for Sinonasal Malignancy
Palliative Considerations
Specific Tumor Considerations
Squamous Cell Carcinoma (SCC)
Adenoid Cystic Carcinoma
Non-salivary Type Adenocarcinoma
Sinonasal Undifferentiated Carcinoma (SNUC)
Esthesioneuroblastoma (Olfactory Neuroblastoma)
Mucosal Melanoma
Conclusion
References
Part III: Orbit
21: Orbital Tumors
Introduction
Anatomy
Bones
Periorbita and Orbital Adipose Tissue
Extraocular Muscles
Intraorbital Cranial Nerves
Orbital Vessels
The Work-Up
Clinical
Radiological
Pathology
Primary Lesions
Vascular Lesions
Secondary Lesions
Do-Not-Operate Lesions
Differential Diagnostics
Optic Nerve Sheath Meningiomas (ONSMs)
Diagnosis
Clinical Examination
Imaging
Treatment Algorithm
Brief Description of Surgery
Spheno-Orbital Meningioma
General Description
Diagnosis
Clinical
Radiological
Treatment Algorithm
Brief Description of Surgery
Cavernous Hemangioma
General Description
Diagnosis
Clinical Examination
Imaging
Treatment Algorithm
Brief Description of Surgery
Conclusion
References
Part IV: Middle Cranial Fossa: Cavernous Sinus
22: The Cavernous Sinus: Surgical ApproachesâEndoscopic and Open
Introduction
Surgical Anatomy
Osseous Relationships
Clinical Significance
Dural Relationships
The Lateral Wall
The Medial and Anterior Walls
Clinical Significance
Vascular Relationship
Arterial
Venous
Clinical Significance
Neural Relationships
Clinical Significance
Anatomic Triangles
Surgical Approaches to the Cavernous Sinus
Transcranial Surgical Approaches
Anterolateral Transcavernous Approach (Dolencâs Approach)
Operative Procedure (Fig. 22.2)
Modifications of the Anterolateral Approach to the Cavernous Sinus
Lateral: The Middle FossaâKawase Approach
Combined Anterolateral and Middle Fossa Approach
Endoscopic Surgical Approaches
The Endoscopic Endonasal Approach to the Medial Cavernous Sinus
The Endoscopic Endonasal Approach to the Anterior Inferior Cavernous Sinus
Surgical Decision-Making Strategy
Conclusion
References
23: Cavernous Sinus Meningioma
Introduction
Natural History
Clinical Presentation
Management
General Treatment Algorithm
Conservative Management
Microsurgery
Transcavernous Biopsy
Maximal Safe Tumor Resection
Aggressive Surgery
Cavernous Sinus Exenteration
Radiation Treatment
Stereotactic Radiosurgery
Fractionated Stereotactic Radiotherapy (FSRT)
Multimodality Therapy
Newer Modalities
Conclusion
References
24: Pituitary Adenoma
Introduction
Epidemiology
Pathology
Diagnosis
Management Strategies
Surgery Described
Surgical Technique: Expanded Endoscopic Endonasal Approach to Cavernous Sinus
Case Illustration
Summary Algorithm for Management
Conclusion
Compliance with Ethical Standards
References
25: Schwannoma
Introduction
Pertinent Pathology and Anatomy
Imaging
Trigeminal Schwannoma
Abducens Schwannoma
Oculomotor Schwannoma
Internal Carotid Artery Plexus Schwannoma
Trochlear Schwannoma
Treatment Options
âOpenâ Craniotomy
Endoscopic Endonasal Approach
Radiosurgery
Conclusion
References
26: Chordomas and Chondrosarcomas Involving the Cavernous Sinus
Introduction
Definition and Histopathology
Clinical Presentation
Imaging
Surgical Considerations
Surgical Approaches
Adjuvant Treatment
Illustrative Cases
Case 1: Clival Chordoma Involving CS
Case 2: Petroclival Chondrosarcoma Involving CS
Conclusion
References
Part V: Middle Cranial Fossa: Meckelâs Cave
27: Open Surgical Approaches to Meckelâs Cave
Introduction
Anatomy
Open Approach to Meckelâs Cave
Subtemporal/Middle Fossa Interdural Approach
Positioning
Craniotomy
Middle Fossa Dissection and Meningeal Dura Elevation (Video 27.1)
Anterior Petrosectomy
Dural/Tentorial Incision
Porus Trigeminus Opening
Tumor Resection
Closure
Case Example (Video 27.1)
Conclusions
References
28: Endoscopic Endonasal Approach to Meckelâs Cave
Introduction
Operative Technique
Case Example
Conclusions
References
29: Trigeminal Schwannoma
Introduction
Classification
Clinical Presentation
Evaluation
General Considerations for Management
Preoperative Considerations and Surgical Approach
Operative Anatomy
Microsurgical Approaches for the Resection of TSs
Retrosigmoid Approach
Pterional/Frontotemporal Approach
Orbitozygomatic or Zygomatic Infratemporal Approach
Subtemporal Approach
Anterior Petrosectomy Approach
Postoperative Considerations
Endoscopic Endonasal Surgical Approach
Stereotactic Radiosurgery
Conclusion/Pearls and Pitfalls
References
Part VI: Intracanalicular Vestibular Schwannoma
30: Middle Fossa Approach for Hearing Preservation
Introduction
Hearing Preservation
Initial Hearing Preservation Following Middle Fossa Approach
Long-Term Hearing Preservation After Middle Fossa Approach
Factors Impacting Hearing Preservation
Tumor Size
Nerve of Origin
Fundal Fluid Cap
Facial Nerve Outcomes
Complications
Surgical Procedure
Monitoring
Conclusion
References
Part VII: Retrosellar Region
31: Expanded Middle Fossa Approach: The Extradural Anterior Petrosectomy
Introduction
Surgical Anatomy
Description of the Technique
Patient Positioning and Preparation
The Extradural Anterior Petrosectomy
Intradural Step (Fig. 31.3)
Closure
Variations Depending on the Tumor Extension
Clinical Applications
Potential Risks
Anatomical Limitations
Conclusion
References
32: The Pretemporal Transcavernous Approach
Introduction
Relevant Anatomy
Surgical Approach
Step 1: FTOZ Craniotomy
Step 2: Exposing and Drilling the Anterior Clinoid Process (ACP)
Step 3: Mobilization of Neurovascular Structures
Step 4: Drilling the PCP and Dorsum Sellae (Figs. 32.2 and 32.3)
Case Examples
Conclusion
References
33: Endoscopic Endonasal Transcavernous Approach
Introduction
Indications and Contraindications
Step-by-Step Technique: Endoscopic Endonasal Transcavernous Approach
Complications
Conclusion
Technical Pearls
References
Part VIII: Posterior Fossa
34: Open Surgical Approaches to the Posterior Fossa
Introduction
Retrosigmoid Approach
Posterior Transpetrosal Approaches
Far Lateral Approaches
Combined Transpetrosal Approaches
Transoral Approach
Functional Preservation Strategy
Selection of Approach
Surgical Adjuncts
Complication Avoidance and Management
Conclusion
References
35: Endoscopic Endonasal Transpterygoid Approaches to the Posterior Fossa
Introduction
Preoperative Considerations
Surgical Procedure
Patient Positioning
Nasoseptal Flap
Nasal Septectomy and Bilateral Sphenoidotomies
Maxillary Antrostomy and Exposure of Pterygopalatine Fossa
Drilling of the Vidian Canal and Identification of Horizontal ICA
Petrous Apex
Infrapetrous Approach
Jugular Foramen/Transcondylar/Hypoglossal Canal Approaches
Contralateral Transmaxillary Approach
Reconstruction
Postoperative Management
Functional Preservation Strategy
Complications
Selection of Approach
Conclusion
References
36: Keyhole Approaches to the Posterior Fossa
Introduction
History
Role of the Endoscope
Anatomy
Keyhole Concept
Midline Supracerebellar-Infratentorial Approach
Upper Cerebellopontine Approach
Middle Cerebellopontine Approach
Lower Cerebellopontine Approach
Midline Infracerebellar Approach
Conclusion
References
37: Petroclival Meningiomas
Introduction
Epidemiology
Pathology
Diagnosis
Management
Surgical Approaches to Petroclival Meningiomas
Retrosigmoid Approach
Anterior Transpetrosal Approach (Kawase Approach)
Posterior Transpetrosal Approach
Combined Petrosal
Case Example
Pretemporal Transcavernous Anterior Petrosal Approach (Modified Dolenc-Kawase)
Case Example
Endoscopic Endonasal Approach
The Combined Pretemporal Transcavernous Anterior Petrosal Approach and Endoscopic Endonasal Approach (PTAPE)
Case Example
Foramen Magnum Meningiomas
Case Example
The Role of Radiotherapy
Management Algorithm
Conclusion
References
38: Vestibular Schwannomas
Introduction
Clinical Manifestations
Radiological Evaluation
Anatomical Nuances
Preoperative Considerations
Surgical Approaches
Surgical Technique
Retrosigmoid Approach
Middle Fossa Approach
Translabyrinthine Approach
Neuromonitoring
Facial Nerve Preservation Techniques
Hearing Preservation Surgery
Radiosurgery
Conclusion
References
39: Cerebellopontine Angle Epidermoid Tumors
Introduction
Pathology
Clinical Presentation
Radiological Imaging
Treatment Options
Conservative Nonoperative Management
Surgical Resection
Functional Preservation Strategy
Conclusion
References
40: Chordomas and Chondrosarcomas of the Posterior Fossa
Introduction
Embryology and Historical Description
Epidemiology
Histology
Chordoma
Chondrosarcoma
Radiological Features
Prognostic Factors
Therapeutic Options
Surgery
Endoscopic Surgical Anatomy of the Clival Region
Preoperative Considerations
Endoscopic Endonasal Transclival Approach
Open/Transcranial Approaches
Radiotherapy
Systemic Medical Treatment
Case Illustration 1: CCJ Chordoma â Unilateral Far-Lateral Approach with Endoscopic Assistance (Figs. 40.2 and 40.3)
Case Illustration 2: Clival Chordoma â Endoscopic Endonasal Transsphenoidal Approach (Fig. 40.4)
Case Illustration 3: Jugular Foramen Chondrosarcoma â Endoscopic Endonasal Approach (Fig. 40.5)
Conclusion
References
41: Pineal Tumors
Introduction
Anatomy
Epidemiology and Pathology
Diagnosis
Surgical Procedures
Streotactic Biopsy
Endoscopic Biopsy
Surgical Approaches
Supracerebellar Infratentorial Approach
Occipital Interhemispheric Transtentorial Approach
Combined Supra- and Infratentorial Approach
Postoperative Care
Overall Management of Pineal Tumors and Use of Adjuvant Therapies
Conclusion
References
42: Brainstem Cavernous Malformations
Introduction
History of Brainstem Cavernous Malformations
Pathophysiology
Clinical Presentation
Diagnosis
Recurrent Lesions
Lawton Brainstem Cavernous Malformation Grading System
Surgical Management
Criteria for Surgical Intervention
When to Operate: One Bleed Versus Two Bleeds?
âWorkhorseâ Surgical Approaches
Midbrain CM Lesions
Anterolateral Lesion
Posterolateral Lesion
Posteromedial Lesion
Pontine CM Lesions
Anterolateral Lesion
Posterior Lesions
Medullary CM Lesions
Anterior and Anterolateral Lesions
Posterior and Posterolateral Lesions
Technical Nuances
Tenets of BSCM Resection
Two-Point Surgical Method
Right-Angle Rule
Instrumentation
Modern Therapeutic Advancements
Role of Microsurgical Technique
Perioperative Imaging
Minimally Invasive Endoscopic Approach
Radiosurgery: A Word of Caution
Operative Technique Optimization
Predictors of BSCM Recurrence
Prognosis
Conclusions
References
43: Cranial Nerve Hyperfunction Syndromes With and Without Vascular Compression and Tumor
Introduction
Trigeminal Neuralgia
Trigeminal Neuralgia: Microvascular Decompression
Procedural Details
Trigeminal Neuralgia: Radiofrequency Rhizotomy
Procedural Details
Trigeminal Neuralgia: Balloon Compression
Procedural Details
Trigeminal Neuralgia: Glycerol Rhizotomy
Procedural Details
Trigeminal Neuralgia: Radiosurgery
Procedural Details
Hemifacial Spasm
Procedural Details
Glossopharyngeal Neuralgia
Procedural Details
Conclusion
References
Part IX: Jugular Foramen Region
44: Open Surgical Approaches to the Jugular Foramen
Introduction
Preoperative Considerations
Surgical Approaches
Posterolateral Approaches
Retrosigmoid
Far-Lateral Approach and Its Variants
Anterolateral Approaches
Postauricular Infratemporal Approach
Postauricular Transtemporal Approach
Preauricular Subtemporal-Infratemporal Approach
Functional Preservation Strategy
Selection of Approach
Complication Avoidance
Conclusion
References
45: Endoscopic Endonasal Approaches to the Jugular Foramen
Introduction
Anatomic Landscape of the Jugular Foramen
The Endoscopic Approach to the Jugular Foramen
Indications
Operative Technique and Exposure
Patient Positioning and Surgical Adjuncts
Surgical Instrumentation
Description of Approach
Clinical Case Example
Conclusion
References
46: Jugular Foramen Meningiomas
Introduction
Clinical Manifestations
Radiological Evaluation
Relevant Anatomy
Preoperative Considerations
Surgical Approach
Surgical Technique
Neuromonitoring
Facial Nerve Preservation Techniques
Lower Cranial Nerve Preservation Techniques
Complications
Long-Term Outcomes
Radiotherapy
Conclusion
References
47: Jugular Foramen Schwannomas
Introduction
Clinical Manifestations
Anatomical Nuances
Radiological Evaluation
Classification
Management Considerations
âDo No Harmâ
Surgical Approach/Technique
Neuromonitoring
Facial Nerve Preservation Techniques
Lower Cranial Nerve Preservation Techniques
Radiosurgical Options
Long-Term Outcomes (Table 47.1)
Conclusion
References
48: Paraganglioma
Introduction
Pathophysiology
Genetics
Tumor Classification
Clinical Presentation
Imaging Characteristics and Differential Diagnosis
Genetic and Metabolic Workup
Treatment Options
Gross Total Resection
Subtotal Resection
Radiotherapy
Observation
Treatment Decision Tree
Metastatic Tumors
Secreting Tumors
Intracranial Mass Effect on the Brainstem
Failure of Local Control After Prior Treatment
Pretreatment Severe Facial Nerve Paralysis
Surgery: GTR Versus STR
Surgical Contraindications
Age
Unanswered Questions
Conclusion
References
49: Chondrosarcoma
Introduction
Surgical Anatomy
Histopathological Features
Clinical Presentation
Management
Surgical Approaches to the Jugular Foramen
Anterolateral Approaches
Posterior Approaches
Midline Anterior Approaches
Surgical Compartments of the Jugular Foramen
Combined Approach: Expanded Endoscopic Endonasal Far Medial Approach and Postauricular Transtemporal Approach
Approach Selection Process (Fig. 49.6)
Adjuvant Therapy
Case Example
Conclusion
References
Part X: Infratemporal Fossa
50: Open Approaches âPreauricular Transcranial Infratemporal Fossa Approaches for Radical Resection of Tumors in or Around Infratemporal Fossaâ
General Principles
Operating Room Equipment, Imaging Technology, and Surgical Instruments
Surgical Anatomy
Pathology
Roadmap to Reach a Decision
Surgical Planning, Strategy, and Complication Avoidance
Preservation of Key Neurovascular Structure
Basic Settings of Surgical Materials for Microsurgery
Surgical Technique
Surgical Concept of Infratemporal Fossa Approach
Preauricular Transzygomatic âAnteriorâ ITF Approach (AITFA)
Positioning and Skin Incision
Transzygomatic Craniotomy
Middle Fossa Exposure
Glasscock Triangle and Petrous Portion of ICA
Middle Fossa Drilling and Skeletonization of V2
Preauricular Transzygomatic âMiddleâ ITF Approach (MITFA)
Positioning, Skin Incision, Craniotomy, and Middle Fossa Exposure
Middle Fossa Drilling and Skeletonization of V3
Parapharyngeal Space Exposure
Necessity of Preservation of the TMJ
Vascularized Pericranial Flap and Skull Base Reconstruction
Conclusion
References
51: Endoscopic Endonasal Approaches to the Infratemporal Fossa
Introduction
Case Example
Operative Technique
Conclusion
References
52: Surgery of Paraganglioma
Introduction
Operating Room Equipment, Imaging Technology, and Surgical Instruments
Surgical Anatomy
Clinical Manifestation and Classification
Roadmap to Reach a Decision
Surgical Indication, Strategy, and Complication Avoidance
Complication Avoidance in GJ Surgery
Facial Nerve Mobilization
ICA Engulfment
Preservation of LCNs
Preservation of Key Neurovascular Structures
Basic Settings of Surgical Materials for Microsurgery
Surgical Technique
Surgical Approach Variation
Transjugular Approach
Transmastoid Approach with High Cervical Exposure (The Combined Transmastoid Retro- and Infralabyrinthine Transjugular Transcondylar Transtubercular High Cervical Approach)
Less Invasive Transjugular Approach with Fallopian Bridge Technique
Transotic Approach
Conclusion
References
53: Juvenile Nasopharyngeal Angiofibroma
History and Presentation
Diagnosis and Imaging
Staging
Histology
Origins of JNA: Hormonal and Molecular Theories
Treatment Options
Surgical Considerations/Pearls
Recurrence: Rates and Treatment
Conclusion
References
54: Schwannoma
Introduction
Epidemiology
Surgical Anatomy
Pathology
Diagnosis
Management Strategies (Fig. 54.6)
Treatment Selection
Surgical Approach
Radiotherapy
Case Examples
Conclusions
References
Part XI: Petrous Bone
55: Cholesterol Granulomas and Endolymphatic Sac Tumors
Introduction
Surgical Anatomy
Pathology
Clinical Presentation
Diagnosis
Management
Illustrative Cases
Conclusions
References
Index
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