Overview of skull base surgery John R. Ouma MB ChB (Makerere), MMed (Neurosurg) Witwatersrand, FCS (SA) Neuro University of the Witwatersrand, Johannesburg & Chris Hani Baragwanath Hospital Department of Neurosurgery 22 nd PAANS scientific meeting Kampala, Uganda Sunday June 5 th 2016

The skull base – some facts Complicated & intricate anatomy Long & difficult procedures Steep learning curves Devastating complications

The skull base - the neighbourhood Naso/oro pharynx Upper airway Upper digestive tract Cranial circulatory system Cranial nerves Cerebellum Brain stem

The skull base Anterior cranial fossa Middle cranial fossa Posterior cranial fossa

The skull base The inferior skull base – Midline vs lateral approaches – Multiple related structures

Skull base pathologies Neoplasms – Peculiar per fossa. Primary and secondary Vascular lesions – Aneurysms and AVM’s Traumatic lesions – Skull base fractures Developmental anomalies – Encephalocoeles

Neoplasms

Vascular lesions

Traumatic lesions

Developmental lesions

Nuances and adjuncts in managing these lesions Various approaches Intricate understanding of anatomy Detailed pre-op preparation “More bone less brain” Anticipation of complications Appropriate skill set and support Appropriate equipment Neurointerventional service Post-operative care

Surgical approaches to skull base lesions Open approaches Endoscopic endonasal approaches

Open approaches

Endoscopic endonasal approaches Excellent visualization Steep learning curve Costly equipment Good outcomes possible