The Fruits of Reinvention Surgery related to the human head, its compartment and contents has been reinvented over the past 40 years. A number of instruments, most notably the sophisticated medical imaging device and the operating microscope, have principally fueled this evolution. Along the way, endoscopy and sophisticated navigation capabilities have added to the realization of a unique comprehension of normal and abnormal microanatomy permitting corridors and manipu- tions that allow novel strategies for surgery in these highly vital functional areas. Cappabianca, Califano and Iaconetta have created a detailed and fully modern review of methods and strategies related to complex surgery and therapies associated with this robust reinvention. Technical innovations abound! Distinguished practitioners of these unique developments in the history of surgical - terprise present these amazing technical exercises. The catalog of these approaches, inst- mentation, techniques, strategies and manipulations is inspiring and stands as a testimony to the remarkable progress that we have witnessed in recent decades. The presentation in truly “modern” and represents in many aspects pinnacles of operative achievement. We must ask ourselves, what will be next? Los Angeles, November 2009 Michael L.J. Apuzzo, M.D., Ph.D (hon) Preface We belong to a lucky and happy generation, living during a period of many dramatic, if not revolutionary, technical and technological innovations, such as the digital era, which have changed and improved our routine surgical practice, together with the quality and quantity of life of our patients.

The second edition of Atlas of Skull Base Surgery and Neurotology presents an up-to-date reference for the latest techniques in the challenging area of skull base surgery.

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.

The essential multidisciplinary guide for the prevention and management of vascular injury from master skull base surgeons Vascular injury is the most significant source of morbidity or mortality during skull base surgery, regardless of the surgical approach. While skull base approaches always placed arteries and veins at risk, newer endoscopic endonasal approaches have introduced new challenges for the prevention and management of vascular injury. Greater anatomic knowledge, additional surgical options, improved instrumentation, advances in interventional neuroradiology, and enhanced training all contribute to successful outcomes. Vascular Challenges in Skull Base Surgery by renowned skull base experts Paul Gardner, Carl Snyderman, Brian Jankowitz, and distinguished contributors, fills a gap in the literature, with invaluable guidance on managing rare but potentially catastrophic surgical complications. The full range of surgical approaches to the anterior, middle, and posterior cranial fossae are covered in 22 chapters. Diverse topics encompass open and endoscopic endonasal surgical approaches, endovascular techniques including balloon test occlusion and embolization, and standard and alternative bypass procedures. The last three chapters discuss venous considerations, neurophysiologic monitoring, and the role of training and simulation in vascular injury prevention. Key learning points, illustrated discussion of relevant anatomy, and tips and tricks are targeted at helping skull base surgeons leverage practical strategies to improve patient outcomes. Key Highlights An impressive group of expert, highly-experienced surgeons share firsthand knowledge Insightful analyses of root causes and clinical pearls provide indispensable prevention tactics High-quality images and videos enhance visual understanding of surgical anatomy and techniques Trainees and practicing skull base surgeons will greatly benefit from the collective knowledge and evidence-based injury avoidance strategies shared by authors who have learned to master the art of skull base surgery.

In recent years, interest in the management of anterior skull base tumors has been fostered by the introduction and subsequent rapid expansion of indications of transnasal endoscopic techniques. In parallel, extraordinary progress has been made in all the other disciplines which are involved in the complex process of managing anterior skull base tumors, leading to substantial improvements in diagnosis and treatment. The anterior skull base can be involved in a large variety of tumors of a varying nature and histology, which in the majority of cases originate from adjacent anatomic sites. In fact, primary lesions of the anterior skull base mainly include osteoma and other tumors originating from bone and cartilage. Tumors involving the anterior skull base have their origin prevalently in the sinonasal tract, but lesions developing on the intracranial site, such as meningiomas, may also extend caudally to encroach upon this area. All these lesions are rare, which means that the pertinent literature does not include prospective studies or treatment guidelines based on a high level of evidence. In view of the extreme histological variability of lesions involving the anterior skull base, much emphasis has been placed on addressing the different nuances of treatment in relation to histology, especially for malignant tumors. The chapters focusing on surgery provide divergent views on selection criteria for a specific surgical technique, which is the aim of this publication.

The quintessential guide to endoscopic skull base reconstruction from multidisciplinary experts Due to close collaboration between otorhinolaryngologists and neurosurgeons, endoscopic endonasal brain surgery has become part of the surgical armamentarium for successful treatment of various cranial base pathologies. Today, it is considered the gold standard surgical technique for many types of skull base tumors. Techniques and Key Points for Endoscopic Cranial Base Reconstruction by pioneering otorhinolaryngologist Carlos D. Pinheiro-Neto and neurosurgeon Maria Peris-Celda, co-editor of Thieme's acclaimed Rhoton's Atlas of Head, Neck, and Brain, encompasses the most important endoscopic cranial base reconstruction techniques performed in the last two decades. The book features contributions from an impressive group of additional experts in this field. Comprised of 26 reader-friendly chapters divided into seven sections, the book starts with discussion of general principles of endoscopic cranial base reconstruction. Sections II through VI provide step-by-step descriptions of reconstructive approaches utilizing diverse flaps including nasoseptal, intranasal, extranasal, and free grafts, followed by free flaps. The final section details management of seven challenging cases that enrich practical clinical experience, from free flap reconstruction to recalcitrant cerebrospinal fluid leak. Key Highlights Decision-making rationales and pearls regarding selection of the most efficacious reconstructive techniques. Consistently formatted chapters feature a succinct review of anatomical concepts integral to each procedure, detailed descriptions for each surgical step, and alternative options. High-quality and meticulous anatomical dissections performed at the editors' anatomy laboratory and beautiful illustrations depict the flow of operations essential to understanding surgical nuances. Nineteen narrated videos visually demonstrate techniques and consolidate learning. This must-have, comprehensive resource will help skull base surgeons master the latest techniques, avoid complications, and achieve improved outcomes for their patients.