title: Perioperative and intraoperative maneuvers to optimize surgical outcomes in skull base surgery.
abstract: There are many approaches to obtaining a workable endoscopic surgical field in sinus surgery. With extended sinus and transdural endoscopic surgery, a more rigid approach must be taken. There are 3 main factors that invariably lead to poor surgical outcomes in endoscopic sinus and skull base surgery: bleeding, inadequate access, and unidentified anatomic anomalies. Bleeding is arguably the most common reason for incomplete resection. An understanding of microvascular and macrovascular bleeding allows a more structured approach to improve the surgical field in extended endoscopic surgery. The endoscopic surgeon should always be comfortable in performing the same procedure as an open operation. However, converting or abandoning an endoscopic procedure should rarely occur because much of this decision making should take place preoperatively. Along with poor hemostasis, inadequate access is an important cause of poor outcome. Evaluation of the anatomy involved by pathology but also the anatomy that must be removed to allow adequate exposure is important. This article reviews the current techniques used to ensure optimal surgical conditions and outcomes.
authors.affiliation: Rhinology and Skull Base, Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, 354 Victoria Street, Sydney, NSW 2010, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Timperley
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Parkinson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
mesh_terms: D001778:Blood Coagulation Disorders / Q000628:therapy; D019587:Dietary Supplements; D004621:Embolization, Therapeutic; D004724:Endoscopy; D018475:Head-Down Tilt; D006488:Hemostasis, Surgical; D006489:Hemostatic Techniques; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008438:Maxillary Artery / Q000601:surgery; D009666:Nose / Q000098:blood supply; D010256:Paranasal Sinuses / Q000601:surgery*; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome