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Published: 2022-09-30
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Surgery of the skull base as a new section in Acta Otorhinolaryngologica Italica

Department of Otolaryngology, Neurosciences Dept. University Hospital of Padova, Padova, Italy; Formerly Otolaryngology Department, Neurosciences Dept., Ospedali Riuniti, Bergamo, Italy
skull base surgery skull base tumour skull base approaches microsurgery of the skull base endoscopic approaches to the skull base

Dear Editor,

The awareness of diseases and surgery of the skull base began in the 1960s with meetings of experts and reports in the literature. The fundamental papers by House 1,2, and Fisch 3-5 on skull base surgery appeared between 1961 and 1978 in the otological community, while the term appeared in the Acta Italica (Archivio Italiano ORL) in 1974 6.

Surgery of the skull base went through a quick and brilliant development, otologists and neurosurgeons promptly adopted the basic principles of skull base approaches. The literature of the last quarter of the century was rich with original and innovative contributions 7-10 and continued to the present times when surgery of the skull base seems to have achieved its full degree of maturity.

The key of skull base surgery is that it extends the room for surgical maneuvers to the skull base itself, beyond the traditional boundaries of the neck and endocranium. It is directed to lesions lying in the base, or the bony diaphragm separating the endocranium from neck and face, but also to adjacent areas, either endo- or esocranial, which can be better exposed if the skull base is part of a new or conventional approach. In malignancies, this principle involves enlargement of resection in safe tissues and is becoming part of modern oncological surgery.

It often combines techniques belonging to different specialties and can involve the collaboration of two or more specialists or a single surgeon mastering the different techniques.

This surgery is mostly microsurgery and includes the microscope and the more recent endoscope and exoscope. The microscope and, to a similar extent the exoscope, works at distance through a cone shaped access with a large entry gate to a small target, achieving various angles of view and bimanual manoeuvers. The endoscope adopts a small entry gate with progressive enlargement and offers angled optics to bypass obstacles.

Skull base surgery can treat a large number of primary diseases (chondrosarcoma, chordoma, paraganglioma, meningioma, haemangioma, schwannoma, and other benign and low-grade malignant tumours, sino-nasal tumours), and their management is often a debated issue. The treatment of temporal bone primary malignant tumours still involves insufficient information of growth modalities and, in individual cases, of tumour extent. Preservation of function and cure of the disease is also an issue in the management of vestibular schwannoma and jugular foramen paraganglioma, where different options can be offered. Moreover, skull base surgery can control perineural infiltration of head neck malignancies and of tumours arising intradurally in the endocranium crossing the skull base to the esocranial compartment, and vice versa.

Today, education is a prominent issue facing skull base surgery to provide the improvement that the specialty deserves. It deals with the formal teaching in academic centres, the simultaneous training of the surgeon and the need for dedicated centres.

In conclusion, I am convinced that this still growing super subspecialty, entrusted to a few hub centres and several skilled individual surgeons, as well as to the scientific community, is ready to receive the favoured and authoritative attention of our journal.

Conflict of interest statement

The author declares no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

  1. House WF. Surgical exposure of the internal auditory canal and its content through the middle cranial fossa. Laryngoscope. 1961; 71:1363-1385.
  2. House WF. Transtemporal bone microsurgical removal of acoustic neuromas. Arch Otolaryngol. 1964; 80:601-750.
  3. Fisch U. Infratemporal fossa approach to lesions in the temporal bone and base of the skull. Arch Otolaryngol. 1979; 105:99-107. DOI
  4. Fisch U, Mattox D. Microsurgery of the skull base. Georg Thieme: Stuttgard/New York; 1988.
  5. Fisch U, Valavanis A, Yasargii MG. Neurological surgery of the ear and the skull base. Kugler: Amsterdam; 1989.
  6. Mazzoni A. Jugulo-petrosectomy. Arch Ital Otol Rinol Laryngol. 1974; 2:20-25.
  7. Derome PJ. Operative neurosurgical techniques. Grune and Stratton: New York; 1982.
  8. Crockard HA. The transoral approach to the base of the brain and upper cervical cord. Ann Roy Coll Surg Engl. 1985; 67:321-325.
  9. Snyderman CH, Carrau RL, Kassam AB. Endoscopic skull base surgery: principles of endonasal oncological surgery. Surg Oncol. 2008; 97:658-664. DOI
  10. Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol. 1990; 247:63-76. DOI

Affiliations

Antonio Mazzoni

Department of Otolaryngology, Neurosciences Dept. University Hospital of Padova, Padova, Italy; Formerly Otolaryngology Department, Neurosciences Dept., Ospedali Riuniti, Bergamo, Italy

Copyright

© Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale , 2022

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