CHOICE OF NEUROSURGICAL APPROACH IN THE TREATMENT OF CRANIAL BASE LESIONS

The authors describe a series of surgical approaches that they found p articularly useful for the exposure and removal of lesions involving t he skull base. These are: 1) fronto-naso-orbital approach; 2) fronto-t emporo-orbito-zygomatic approach; 3) subtemporal transpetrosal approac h; 4) temporo-suboccipital transpetrosal approach (retrolabyrinthine p resigmoid; transsigimoid; translabyrintine amend transcochlear presigm oid); 5) dorsolateral approach to the foramen magnum and lower CliVUS. As the approaches are complex and carry potential risks of morbidity, not only it is important to have a good knowledge of basic anatomy bu t also to closely follow the indications for each one. In this type of surgery where it is often difficult to achieve complete removal of th e lesion by a single route of attack, more than one approach may be em ployed in different surgical steps. Finally, all these approaches dema nd extremely scrupulos surgical reconstruction to avoid dangerous post operative complications that may jeopardize the previous work of the s urgeon.