REVIEW OF SKULL BASE SURGERY APPROACHES - WITH SPECIAL REFERENCE TO PEDIATRIC-PATIENTS

The techniques of skull base surgery attempt to maximize the exposure of a cranial base lesion while using the least amount of brain retract ion. Cranial base surgery is not a 'new' area of neurosurgical or otol aryngologic interest, but instead represents a resurgence of efforts t o treat difficult lesions involving the cranial base. This resurgence of interest and effort is a product of recent advances in microanatomi cal knowledge of the cranial base, advances in microsurgical technique , improved neurophysiologic monitoring, and improved collaborative rel ationships between neurosurgery, otolaryngology and plastic surgery. F urthermore, improved neuroanesthetic techniques allow the surgeon to p roceed with surgery without undue concern about time, and improved neu roimaging techniques provide the surgeon with detailed knowledge of th e three dimensional characteristics of the tumor and surrounding struc tures [1]. This review will focus on the surgical management of crania l base tumors primarily affecting the pediatric population. Little has been written on the techniques of skull base surgery as they apply to the pediatric population, since cranially-based tumors are a relative ly rare occurrence in this patient population. In most instances, howe ver, many of the 'standard' skull base approaches can be applied to th e pediatric patient with few modifications, and in our experience, the pediatric patients have tolerated these approaches as well as their a dult counterparts.