SKULL BASE SURGERY - A NEW CONCEPT IN REGIONAL SURGERY.

Surgery of the skull base has evolved over the past 100 years. This anatomical area has been approached by neurosurgeons, otologists, maxillofacial surgeons and plastic surgeons from different angles. Presently, the combined skills of these surgeons are utilized in treating lesions of this area once considered a 'bony no man's land'. Modern microsurgical techniques are based on the principle that removal of adequate bone from the cranial base could provide sufficient access without the necessity to retract dura. Accurate preoperative assessment by imaging, the use of microsurgical techniques, preservation of vital structures such as nerves by intraoperative monitoring, and modern anaesthetic and postoperative management have all contributed to the reduction in mortality and morbidity to acceptable levels. In the future, with refinements in imaging, stereotactic radiosurgery and chemotherapy, the above management protocol would be tailored to suit each individual patient and decided by a team of experts.