Abstract
The authors' principle of surgical treatment for nine cases of skull base space-occupying lesions extending both intra and extracranially, performed by combined surgical teams consisting of neurosurgeons, otolaryngologists, ophthalmologists and plastic surgeons are reported.
Advantages of the simultaneous combined surgical procedure for skull base lesions are as follows: Two surgical teams (i.e. intra and extracranial teams) can exchange information regarding relationships of the lesion extending both intra and extracranially, as well as the process of each surgical procedure, thus eliminating ‘dead angles’, and making the procedure more radical. Under direct observation from the intracranial side, preventive measures against possible postoperative infection can be safely taken from the extracranial side. Therefore, intracranial extension of frequent complications such as mucoceles, pyoceles, cholesteatomas and paranasal sinusitis can be successfully prevented. Closure of the dural or bony defect at the skull base can readily be performed with a pedicled flap (e.g. periosteum, galea, fascia, muscle or dura), together with an autograft of bone if necessary. Continuous spinal drainage is sometimes added as a further precaution against possible CSF leakage. Completeness of closure of the defect is confirmed from both intra and extracranial sides. By performing the two different procedures (i.e. intra and extracranial procedures) simultaneously, the patient's physical and psychological burden can be lightened, and anesthetic time is also shortened.
