Table Of ContentContemporary
Skull Base Surgery
A Comprehensive Guide to
Functional Preservation
A. Samy Youssef
Editor
123
Contemporary Skull Base Surgery
A. Samy Youssef
Editor
Contemporary Skull
Base Surgery
A Comprehensive Guide
to Functional Preservation
Editor
A. Samy Youssef
Department of Neurological Surgery
University of Colorado School of Medicine
Aurora, CO, USA
Department of Otolaryngology
University of Colorado School of Medicine
Aurora, CO, USA
ISBN 978-3-030-99320-7 ISBN 978-3-030-99321-4 (eBook)
https://doi.org/10.1007/978-3-030-99321-4
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Foreword
I am proud to introduce this book Contemporary Skull Base Surgery, A
Comprehensive Guide to Functional Preservation to our community of neu-
rosurgeons. This text completes the journey of A. Samy Youssef from being
my former Skull Base Fellow fellow and then colleague to becoming my
teacher who is defining his vision of what skull base surgery is and how it
should be applied in a more mature multi-disciplinary, multi-modality world.
Samy has earned credibility in this space through countless hours in the
cadaveric laboratory, numerous dissection courses around the world, and his
impressive clinical experience.
If you are planning to recommend or perform a typical skull base tumor
operation, go to the literature to find evidence-based best practices applicable
to your case. They cannot be found. That is the burden of practicing surgery
in a specialty that is characterized by “orphan diseases,” too few cases for a
“controlled study,” too complex and critical for patient randomization, and
too controversial to expect surgeon equipoise. This world of skull base sur-
gery will likely remain.
Senior skull base surgeons manage the void by using their own best judg-
ment acquired by a thousand personal mistakes, poor judgments, and poor
outcomes. Taken together, we call this experience. Is this the path for all
future skull base surgeons and their patients? The answer is no. As has been
said, learn from the mistakes of others, you won’t live long enough to make
them all yourself. Certainly, your patients hope to avoid being thrown upon
the heap of your own cautionary anecdotes in your journey to becoming “an
experienced skull base surgeon.” Contemporary Skull Base Surgery: A
Comprehensive Guide to Functional Preservation will help you on this jour-
ney to become a faster learner and a safer surgeon for your patients.
Dr. Youssef skillfully addresses these complex issues by gathering an
impressive collection of experts who bring their personal experience to voice
with each chapter. Under his guidance, this book brings reasonable consider-
ation to the tension between endoscopic and open surgical approaches to
anterior skull base tumors, trying to advance the debate from proselytization
to reasonable discussion and application.
Keep Contemporary Skull Base Surgery, A Comprehensive Guide to
Functional Preservation near your desk, at home, or at work, wherever you
go to sit and stare at the images of a specific case, with a skull in your hand,
to “imagine the operation.” Find the chapter that addresses your case specifi-
cally. Follow along with the experts in the field who share their very specific
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vi Foreword
wisdom founded in their own experiences, and translations of their own suc-
cesses and failures. With these guides helping you to avoid their mistakes,
envision a surgical plan that will lead to success. And yes, unfortunately, on
occasion, you will still make your own mistakes. That too is the nature of
skull base surgery.
As eloquently stated by Rene Leriche, “Every surgeon carries within him-
self a small cemetery, where from time to time he goes to pray – a place of
bitterness and regret, where he must look for an explanation for his failures.”
Use this book as a guide to keep your cemetery of regret as small as
possible.
Contemporary Skull Base Surgery: A Comprehensive Guide to Functional
Preservation reflects Dr. Youssef’s vision of what is possible in our field and
his passion to make a difference.
Harry R. van Loveren
Department of Neurosurgery and Brain Repair
University of South Florida Health Morsani College of Medicine
Tampa, FL, USA
Preface
For skull base neurosurgeons and neurosurgeons in training, Contemporary
Skull Base Surgery: A Comprehensive Guide to Functional Preservation is a
modern resource with a unifying message. My concept for this book evolved
over a 3-year period to not only encompass recent technological advances in
the operating room and radiology suite but to unify the achievements in our
field from the past with the present.
With support from Springer, the idea was launched to create a comprehen-
sive guide/companion to facilitate the surgeon’s decision-making process and
to support young surgeons in building a successful career in skull base sur-
gery. Contemporary Skull Base Surgery’s contributors and Springer editors
supported the idea of taking a progressive approach in the chapter format by
creating a roadmap for devising optimum treatment strategies for complex
brain pathologies. The authors generously supplemented their chapters with
anatomical figures and surgical videos.
Contemporary Skull Base Surgery addressed a divisive fundamental issue.
As the scope of knowledge expanded within the field of neurosurgery, meth-
odologies became more complex. However, a chiasm of debate among neu-
rosurgeons widened: should surgery be performed by purely endoscopic
approaches or only traditional open approaches? Microsurgery was no longer
the only treatment choice for complex brain pathologies. The evolution of
endoscopic endonasal skull base approaches and the ongoing advances in
radiotherapy enhanced the surgeon’s ability to “do no harm.” Yet, without
integration of these two viewpoints, the selection of an optimum treatment
strategy remained a confounding step.
Further impeding this learning process, current textbooks are typically
either endoscopic or traditional. The few references that combine both do not
guide the reader to which treatment strategy to choose. Therefore, devising an
optimum treatment strategy for complex brain pathologies using the strengths
of both schools of thought became a challenging enterprise.
Contemporary Skull Base Surgery unifies the strengths of both of these
schools of thought, preserving the wisdom of skull base traditions and pro-
moting recent advances in the operating room and radiology. This compre-
hensive guide/companion aims to facilitate the surgeon’s decision-making
process in optimizing treatments for our patients by functional and anatomi-
cal preservation of key neurovascular structures. Contributing authors of this
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viii Preface
text have been in the forefront of designing skull base laboratories; creating
skull base trainings for residents, fellows, and junior-level surgeons; and
leading the design and refinement of instrumentation, technique, and clinical
protocols in our field.
How to Use This Book
Contemporary Skull Base Surgery consists of eleven main sections. The
numerous chapters are written by skull base leaders who guide the reader
with their expertise in surgical technique and technology. Important to this
text are the supplementary surgical and endoscopic videos. Readers are
encouraged to make use of these highly effective training tools, which can
enhance their understanding of the text.
The first section, General Principles, consists of 13 foundational chapters
essential for every skull base surgeon. Contributors acquaint the reader with
the essentials, such as skull base anatomy, development of a multidisciplinary
skull base team, operating room equipment, surgical instruments, and mod-
ern imaging technologies. These authors masterfully convey the key elements
that play a major role in optimizing functional outcomes and patient quality
of life.
The two chapters on compartmental anatomy set the stage for understand-
ing the technical and surgical nuances of each location. The ten subsequent
sections are organized by anatomical compartment or region of the skull base
for uniformity and ease of use. Each section describes the available choices
for treatment to each compartment contributed by world-class neurosurgeons
and otolaryngologists who provide top-level expertise in how to tackle each
pathology.
The surgical approach chapters that follow then lead to a specific anatomi-
cal section. Operative techniques are described in a clear and stepwise man-
ner with accompanying intraoperative photos, illustrations, and surgical
videos.
Chapters addressing individual pathologies depict pathological subtypes
with representative radiographic images of clinical case examples. Each
pathology includes a treatment algorithm based on tumor morphology, preop-
erative clinical status, and the goal of maximum functional preservation that
includes a brief description of surgical approaches. This becomes the reader’s
roadmap, a guide to reach a decision treatment of each patient’s skull base
pathology. (See “How to Use This Book: Example Case”)
Contemporary Skull Base Surgery aims to be a comprehensive, versatile
handbook as well as detailed reference and surgical atlas for skull base sur-
gery. My deep appreciation to the collaborative of contributing authors from
the fields of neurosurgery and otolaryngology who exemplify the unifying
vision and progressive concept of this text, which replaces partisanship with
deeper discussion.
Contemporary Skull Base Surgery uniquely integrates the two main surgi-
cal schools of endoscopy and open surgery into one reference that is enhanced
by treatment algorithms. Over years, trainees candidly shared their sugges-
Preface ix
tions, criticisms, and ideas to better grasp the knowledge component of skull
base surgery. Their input as the next generation of surgeons helped to fuel the
progressive concept of this text. Finally, I wish to acknowledge Dr. Takanori
Fukushima whose gracious encouragement and insight fueled my determina-
tion to envision and produce Contemporary Skull Base Surgery.
Aurora, CO, USA A. Samy Youssef, MD, PhD
How to Use This Book: Example Case
Contemporary Skull Base Surgery focuses to identify the target struc-
tures and to plan an approach that minimizes iatrogenic damage. This
strategy will lead the surgeon down the road of either open, endoscopic,
or a combination of both approaches.
Example: Evaluating a patient with an anterior skull base
meningioma.
• First, go to the section Anterior Cranial Fossa and review the chapter
“Meningioma” to find the optimum treatment strategy based on
tumor size, location, and preoperative functional and anatomical sta-
tus of surrounding neurovascular structures.
• Second, follow the pictorial algorithm for selecting the steps to opti-
mal treatment or surgical choice.
• Third, read the details about the surgical approach selected (endo-
scopic, open, combined, or radiosurgery) in the general section
Anterior Cranial Fossa and reconstruction of the skull base in the
section General Principles.
Summary: Use this decision-making process when seeing a patient
in clinic. Follow with a more detailed study before performing the sur-
gical procedure. Contemporary Skull Base Surgery can be a useful
adjunct for multidisciplinary case discussions and clinical rounds
geared toward finalizing a treatment plan.
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