How to avoid complications in Endoscopic skull base surgery

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This e book discusses the various methods by which complications can be avoided while performing endoscopic skull base surgery
  Avoiding pitfalls in Endoscopic skull basesurgery ByDr. T. Balasubramanian  Safe endoscopic skull base surgery How? Introduction:The advantages of endoscopic approach to skull base are many. They include:1.It is the most direct route to anterior skull base. This approach provides accessto the following areas Sella, Cribriform plate, Planum sphenoidale, suprasellar cistern, Clivus, Pterygopalatine fossa and adjacent parasellar areas.2.In this approach there is decreased retraction of brain and cranial nerves whencompared to that of conventional neurosurgical apporaches.3.Endoscope offers excellent visualization of the tumor and the surroundingneurovascular structures4.Post operative recovery time is short when compared to that of conventionalneurosurgical approachesAs with any other procedure this method also has its flip side, which includes a steeplearning curve, and need to collaborate with neurosurgeon. A cohesive collaborationwith neurosurgeon is a must for successful endoscopic skull base surgical procedures.The complicated anatomy of skull base has managed to bridge these twospecialities. In a nut shell an otolaryngologist navigates the pathway to theintracranial lesion while the neurosurgeon removes the tumor.Dangers of endoscopic skull base surgery:Since the skull base has many vital structures it should be performed with the highestdegree of deligence and skill. The potential complications of any endoscopic skull base surgery include:1.CSF rhinorrhoea2.Injury to great vessels (internal carotid artery and its branches inside the skull)3.Injury to optic nerve4.Injury to other cranial nerves5.Bleeding from cavernous sinus6.MeningitisSteps taken to prevent these complications include:CT MRI scan review:  Meticulous pre operative review of CT and MRI scans of the patient. A CT scan picture not only provides critical information about anatomical landmarks it alsoshows up the anatomical variations. While studying the CT scan images lamina papyracea should be looked for evidence of dehiscence.Coronal CT image showing lamina papyraceaThe degree of pneumatization of sphenoid sinus should be evaluated. This willreveal to the surgeon the exact amount of bone that must be drilled to reach the pathology.
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