Walter C. Jean: Skull Base Surgery: Strategies

Abstract

Skull base surgery has had an enormous impact in the technological revolution of medicine. The augmentation of the scope of knowledge within the field of neurosurgery has made the methodology more complex. Microsurgery is no longer the only treatment choice for complex brain pathologies. The evolution of endoscopic endonasal skull base approaches and the continuous advances in radiotherapy enhanced surgeons’ ability to Bdo no harm^, and there has been a paradigm shift in skull base surgery from aggressive surgical resection at all cost, to maximum functional preservation. Devising an optimum treatment strategy for complex brain pathologies has become a challenging enterprise and hence the need for a modern comprehensive skull base guide. Thieme has recently published Skull Base Surgery: Strategies, an important step toward developing a comprehensive management thought process inclusive of all available treatment tools. The book handles each skull base approach with a novel insight. A hardcover divided into nine sections based on tumor location with a total of 32 chapters. Each section covers a particular tumor location starting from the anterior fossa and going in a 360-degree tour around the skull base in addition to tumors of the brainstem, ventricles, and pineal region. There are 123 worldwide experts including neurosurgeons and otolaryngologists who contributed to this task. Their collective expertise is woven into a smooth flow of operative techniques and strategic decision-making. The cover of the book depicts a chess board symbolizing the struggle surgeons’ face when battling skull base pathology and the strategy required to succeed. The title includes the word Bstrategies^ at the end and therein lies the crux of this book. Each chapter has a consistent structure which makes it easy to read. There is the standard case presentation with preoperative films along with the diagnosis and assessment. This sets the stage for the anatomical and therapeutic considerations in which the authors detail the anatomical relationships of the particular pathology and explain the selection process of an optimum treatment strategy. For example, in the chapter on petroclival fissure tumors, this section spells out how each endoscopic approach changes with subtle location changes in the clival tumor. The majority of the chapters include a subsection labeled options for approach which specifically lay out multiple options and brief description of techniques as well as a subsection on the actual approach chosen and the reasoning behind the selection. This is followed by a clear, eloquent, step by step description of the operative technique with accompanying intraoperative photos and surgical videos. These photos and videos are nicely selected and show the appropriate steps of the operation; however, the illustrations and depictions of operative corridors are a unique feature. A reader simply has to look at these illustrations, such as Fig. 24.11 which shows diagrammed approach options for the endoscopic supracerebellar infratentorial approach through a midline and paramedian trajectories and the resultant views obtained. This kind of clarity serves as a great guide for young neurosurgeons. Finally, each chapter includes easy to identify, colorful tables that explain the three approach elements defined in the opening chapter, operative setup and surgical pearls. These coalesce the chapter down into salient points and allows for quick reference either before or between operative cases. An additional feature that adds class to the publication is the perspective sections after each chapter. These several page additions contribute incredible insight from master surgeons * A. Samy Youssef [email protected]