Cranial base approaches to inaccessible intracranial tumors.
OBJECTIVE
Craniotomy created through the base of the skull has improved exposure of many types of extraaxial tumors and thus enhanced both tumor control and preservation of neural function. The purpose of this article is to review recent advances in this emerging field.


RESULTS
Use of microscopes and endoscopes has allowed these procedures to become progressively less invasive. Electrophysiological monitoring has enhanced neural identification and preservation. The increasingly documented efficacy of stereotactic radiation for certain tumor types (e.g. meningioma, schwannoma) has permitted nonoperative therapy for some individuals. In large tumors, selective use of less-than-complete microsurgical resection is establishing an increasing role, at times combined with focused radiotherapy of the surgical remnant. The role for transbasal craniotomy is well established in both benign tumors and vascular lesions, but has only limited applicability for high-grade malignant lesions. Today, the vast majority of procedures can be conducted in a single stage by a multidisciplinary team.


CONCLUSIONS
Operative trajectories created through the cranial base, although technically demanding, have led to substantially improved outcomes for a wide variety of inaccessible intracranial lesions.
Monfared
Ashkan
A
Stanford Department of Otolaryngology-Head and Neck Surgery, Palo Alto, California 94305, USA.
Agrawal
Sumit
S
Jackler
Robert K
RK
D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D020209:Cranial Nerve Injuries / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008991:Monitoring, Physiologic / Q000592:standards / Q000639:trends; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011878:Radiotherapy / Q000379:methods / Q000639:trends; D019291:Skull Base / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D013238:Stereotaxic Techniques / Q000639:trends