La cirugía de la base del cráneo, es la mas compleja y técnicamente exigente en neurocirugía.

La patología de la base del cráneo como subespecialidad de la neurocirugía precisa para su abordaje integral la actuación de diversas especialidades:

Otorrinolaringología

Cirugía máxilofacial

Radioterapeuta

Oncólogo.

Incidencia relativamente baja; naturaleza frecuentemente benigna; suele afectar a pacientes adultos entre la cuarta y quinta década de la vida.

La más frecuente es la patología tumoral localizada en esta zona anatómica.

Estesioneuroblastoma

Quiste de la bolsa de Rathke

Meningioma de base de cráneo

Neuralgia del trigémino

Schwannoma del nervio vestibular

Tumor hipofisario.

Tumor glómico

Tumor de órbita

Reconstrucción de la base de cráneo anterior

Fístula de líquido cefalorraquídeo

Encefalocele

Displasia fibrosa

Suele ser paucisintomática al inicio, aunque con posibilidad de severos déficits neurológicos si se dejan evolucionar

Fácilmente diagnosticable con las técnicas de imagen actualmente disponibles.

Precisa de secuencias especiales de RM y TAC de cortes finos

Angiografía

Neuromonitorización fisiológica.

Neuronavegación

Son generalmente de gran dificultad técnica con necesidad de abordajes quirúrgicos complejos y, a veces, multidisciplinarios.

Son complejos y requieren un buen conocimiento de la anatomía y técnica quirúrgica.

Abordaje petroso

Abordaje presigmoideo

Abordaje transpetroso

Abordaje transcondilar

Abordaje preauricular

Abordaje al seno cavernoso

Abordaje subtemporal

Abordaje infratemporal

Abordaje al clivus

Abordaje Frontobasal

Abordaje Transcraneal

Abordaje Endonasal Endoscópico Expandido

Abordaje etmoidoesfenoclival endoscópico

Vídeos IRCAD-France-Skull Base Surgery

Universidad de Barcelona-Servicio de Neurocirugía y Otorrinolaringología-Hospital de la Santa Creu i Sant Pau y H. Bellvitge

Artículos Recomendados

1 - Al-Mefty O, Fox JL, Rifai A, Smith RR A combined infratemporal and posterior fossa approach for the removal of giant glomus tumors and chondrosarcomas. Surg Neurol 1987 28(6):423-31

2 - Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery 1988 22:510-7

3 - Al-Mefty O, Texeira A. Complex tumors of the glomus jugulare: criteria, treatment and outcome. J Neurosurg 2002 97(6):1356-66

4 - Ammirati M, Spallone A, Ma J, Cheatham M, Becker D. An anatomicosurgical study of the temporal branch of the facial nerve. Neursurgery 1993 33:1038-44

5 - Cavallo LM, Messina A, Gardner P, Esposito F, Kassam AB, Cappabianca P et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 2005 19(1):E5

6 - Cavallo LM, Messina A, Cappabianca P, Esposito F, de Diviitis E, Gardner P et al. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 2005 49:354-62

7 - Cho CW, Al-Mefty Combined petrosal approach to petroclival meningiomas. Neurosurgery 2002 51(3):708-16.

8 - Díaz Day JD, Kellogg JX, Fukushima T, Giannotta SL Microsurgical anatomy of the inner surface of the petrous bone: neuroradiological and morphometric analysis as an adjunct to the retrosigmoid transmeatal approach. Neurosurgery 1994 34:1003-8.

9 - Díaz Day JD, Kellogg JX, Tschabitscher M, Fukushima T. Surface and superficial surgical anatomy of the posterolateral cranial base: significance for surgical planning and approach. Neurosurgery 1996 65:160-7 10 - Dolenc VV. A combined epi- and subdural direct approach to carotid ophthalmic artery aneurysms. J Neurosurg 1985 62:667-72.

11 - Erkmen K, Pravdenkova S, Al-Mefty O. Surgical management of petroclival meningiomas: factors determing the choice of approach. Neurosurg Focus 2005 19(2):E7. 12 - Fisch U. Infratemporal fossa approach to lesions in the temporal bone and base of the skull. J Laryngol Otol 1978 92(11):949-67. 13 - Frank G, Pasquini E. Endoscopic endonasal cavernous sinus surgery, with special reference to pituitary adenomas. Front Horm Res 2006 34:64-86. 14 - George B, Dematons C, Cophiño J. Lateral approach to the anterior portion of the foramen magnum. Surg Neurol 1988 29:484-90. 15 - Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CJ et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116(10) 1882-6. 16 - Hakuba A, Liu SS, Nishimura S. The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol 1986;26 271-6. 17 - Hakuba A, Tanaka K, Suzuki T, Nishimura S. A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J Neurosurg 1989;71 669-704 18 - House WF, Hitselberg WE. The transcochlear approach to the skull base. Arch Otolaryngol 1976;102 334-42 19 - Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach. Part I and II. Neursurg Focus 2005;19(1) E3-4. 20 - Kassam A, Vescan AD, Carrau RL, Prevedello DM, Gardner P, Mintz A et al. Expanded endonasal approach: vidian canal as a landmark to the petrous internal carotid artery. J Neurosurg 2008;108(1): 177-83. 21 - Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg 1985;63: 857-61. 22 - Lesoin F, Thomas CE 3rd, Pellerin P, Villette L, Autricque A, Jomin M. An orbito-zygomatic-malar bone flap approach: a technical note. Acta Neurochir (Wien) 1986;83(3-4): 154-6. 23 - Miller E, Crockard HA Transoral transclival removal of anteriorly placed meningiomas at the foramen magnum. Neurosurgery 1987;20: 966-8. 24 - Miller CG, Van Lovberen HR, Keller JT, Pensak M, El-Kalliny M, Tew JM. Transpetrosal approach: surgical anatomy and technique. Neurosurgery 1993:33(3): 461-9. 25 - Oliveira E, Rhoton AL Jr, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 1985:24: 293-352. 26 - Pait TG, Harris FS, Paullus WS, Rhoton AL Jr. Microsurgical anatomy and dissection of the temporal bone. Surg Neurol 1977:8: 363-91. 27 - Perneczky A, Knosp E, Matula C. Cavernous sinus surgery. Approach through the lateral wall. Acta Neurochir (Suppl) 1988;92: 76-82. 28 - Raveh J, Turk JB, Lädrach K, Seiler R, Godoy N, Chen J et al. Extended anterior subcranial approach for skull base tumors: long term results. J Neurosurgery 1995; 82(6): 1002-1010 29 - Rhoton AL Jr Neurosurgery 2000; 47 (3 Suppl). 30 - Rhoton AL Jr. Neurosurgery 2002 51 (4 Suppl).

31 - Samii M, Ammirati, Mahran A, Bini W, Sephernia A. Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 1989;24: 12-7. 32 - Samii M, Tatagiba M, Matthies C. Vestibular schwannoma: surgical approach. J Neurosurg 2001;94(1): 144-6. 33 - Sekhar LN, Schramm VL Jr, Jones NF, Yonas H, Horton J, Latchaw RE et al. Operative exposure and management of the petrous and upper cervical internal carotid artery. Neurosurgery 1986;19(6): 967-82. 34 - Sekhar LN, Schramm VL Jr, Jones NF. Subtemporal-preauricular infratemporal fossa approach to large lateral and posterior cranial base neoplasms. J Neurosurg 1987;67(4): 488-99. 35 - Sekhar LN, Janecka IP. Subtemporal-infratemporal and basal subfrontal approach to extensive cranial base tumors. Acta Neurochir (Wien) 1988;92: 83-92. 36 - Sekhar LN, Nanda A, Sen CN, Snyderman CN, Janecka IP. The extended frontal approach to tumors of the anterior middle and posterior skull base. J Neurosurgery 1992;76(2): 198-206. 37 - Sekhar LN, Patel S, Cusimano M, Wright DC, Sen CN, Bank WO. Surgical treatment of meningiomas involving the cavernous sinus: evolving ideas based on a ten year experience. Acta Neurochir Suppl 1996;65: 58-62. 38 - Sen CN, Sekhar JN. The subtemporal and preauricular infratemporal approach to intradural structures ventral to the brain stem. J Neurosurg 1990;73(3): 345-54. 39 - Tedeschi H, Rhoton AL Jr. Lateral approaches to the petroclival region. Surg Neurol 1994;41: 180-216. 40 - Yasuda A, Campero A, Martins C, Rhoton AL Jr, Oliveira E, Ribas GC. Microsurgical anatomy and approaches to the cavernous sinus. Neurosurgery 2005;56(Suppl 1): 4-27.