Basic Principles of Skull Base Surgery

Skull base surgery has a long history of bold and innovative physicians who treat some of the most complex and difficult lesions in the human body. With the introduction of the operating microscope in the 1960s and widespread adoption of the neuroendoscope in the 1990s, skull base surgeons, along with a multidisciplinary team, have managed to treat complex and previously unresectable tumors more safely and effectively than ever before. Here, we provide an overview of skull base surgery and its history, and discuss surgical considerations, including preoperative planning, selecting the appropriate surgical approach, positioning, neuromonitoring, neuroanesthesia, and complication avoidance. We detail core concepts in skull base surgery, patient-specific considerations, the role of intraoperative imaging, methods for brain relaxation, and complication avoidance, anticipation, and management. Although rooted in careful surgical technique, an interdisciplinary approach, and meticulous care of the patient, skull base surgeons remain at the forefront of surgical technology and innovation.