S kull Base Approaches in Children

Abstract

Skull base surgery emerged in the past decades as a subspecialty in the field of neurosurgery. Classical approaches have been described by pioneers, and then they have been developed and refined providing surgeons with a wide variety of corridors to manage complex lesions of the cranial base. Skull base surgery has also, recently, taken advantage of new instrumentation and new devices in the field of endonasal endoscopic approaches for ventral skull base lesions. Which was true for adults was also true for infants and children for whom conventional and more recent techniques have been applied one step after for technical reasons but proved to be feasible and safe. These approaches are divided into anterior, lateral, and posterior approaches. For practical use these routes will be described following the skull base structures (or areas) that are intended to be reached (or where the pathology is located). These approaches can be either extended or combined with each other. The objective of this chapter is to focus on skull base surgery modularity upon which our philosophy is based. Besides, advantages and drawbacks of the different approaches have to be clearly understood in order to make the right surgical approach that means the most “effective” surgery regarding tumor removal and the most “preserving” surgery regarding vasculo-nervous structures that cross the skull base.