title: Skull Base Surgery with Minimal Resources.
abstract: BACKGROUND
  Skull base surgery needs advanced equipment and is performed at few public sector hospitals in India. For financial and infrastructure reasons, the facilities available are insufficient for the large number of poor patients who need this surgery.
  
  
  METHODS
  Neurologically deteriorating poor patients who failed to receive skull base surgery at overloaded public sector hospitals underwent surgery with basic neurosurgical instruments, using the available resources and indigenously designed instruments adhering to the basic principles of skull base surgery. Various lesions operated on in the study were analyzed based on their location and surgical approach.
  
  
  RESULTS
  Ninety-one skull base surgeries in 84 patients were performed during 2013-2015. There were 46 males and 38 females, with an average age of 35 years. Surgical treatment included surgery of the craniovertebral junction (n = 43) and lesions of the anterior skull base (n = 7), middle skull base (n = 10), and posterior skull base (n = 31). Lesions were operated on through anterior (n = 10), lateral (n = 14), and posterior and posterolateral (n = 67) skull base approaches.
  
  
  CONCLUSIONS
  The facilities available in low-income countries such as India are insufficient to take care of poor patients who need skull base surgery. Indigenous innovations, use of the available resources, and interdisciplinary coordination help overcome the challenges of resource scarcity to a reasonable extent in many ill-equipped public sector hospitals for the safe and efficient management of many patients who need skull base surgery.
authors.affiliation: Department of Neurosurgery, Institute of Human Behavior and Allied Sciences, Delhi, India. Electronic address: jhadeepak2@rediffmail.com.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Jha
authors.affiliation: Department of Neuroanesthesia, Institute of Human Behavior and Allied Sciences, Delhi, India.
authors.forename: Mukul
authors.initials: M
authors.lastname: Jain
authors.affiliation: Department of Neuropathology, Institute of Human Behavior and Allied Sciences, Delhi, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Chaturvedi
authors.affiliation: Department of Microbiology, Institute of Human Behavior and Allied Sciences, Delhi, India.
authors.forename: Renu
authors.initials: R
authors.lastname: Goyal
authors.affiliation: Department of Neuroanesthesia, Institute of Human Behavior and Allied Sciences, Delhi, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Arya
authors.affiliation: Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Kushwaha
authors.affiliation: Department of Otolaryngology, Patliputra Medical College and Hospital, Dhanbad, Jharkhand, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Thakur
mesh_terms: D000328:Adult; D003363:Cost Control / Q000191:economics*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D019635:Neurosurgical Procedures / Q000191:economics* / Q000706:statistics & numerical data*; D010027:Osteotomy / Q000191:economics* / Q000706:statistics & numerical data*; D019291:Skull Base / Q000601:surgery*
keywords: Craniovertebral junction; Endoscope assisted; Equipment; Resource scarcity; Skull base surgery