Surgery of skull base tumors.

The management of tumors arising from or, by extension, involving the skull base is complex due to the density and sensitivity of nearby neurovascular structures, the proximity of these structures to the relatively contaminated spaces of the paranasal sinuses or ear and mastoid, the varied pathologic entities encountered, and the relative lack of familiarity with the local anatomy. Dedicated multidisciplinary teams have formed in order to best diagnose, evaluate, and treat patients with these relatively rare disorders. Research in surgical anatomic laboratories continues to refine operative approaches and methods, whereas reevaluations of the methods of preoperative patient neurovascular assessment seek to identify the tests that provide the greatest predictive value with the least risk to the patient. The object of molecular genetic investigation of skull base tumors is to identify the mechanisms of tumorigenesis and possible therapeutic targets for intervention. Advances in surgical, radiotherapeutic, and chemotherapeutic techniques have expanded management options. In some instances, the traditionally adjuvant roles of radiation therapy (including radiosurgery) and chemotherapy have become viable primary forms of therapy. The rich multidisciplinary environment in which skull base surgery has developed has allowed for significant progress in the field and has improved patient outcomes.