The Funnel: From the Skull Base to the Sacrum

Book excerpt: Skull-base surgery is a minimally invasive endoscopic procedure, which involves the surgeon inserting instruments through the natural openings in the skull—the nose or mouth—or by making a small hole just above the eyebrow. This type of surgery requires a team of specialists, which may include ENT (ear, nose, and throat), maxillofacial and neurosurgeons, as well as radiologists. The craniovertebral junction (CVJ) has a unique anatomical bone and neurovascular structure, which not only separates the subaxial cervical spine but also provides a special cranial flexion, extension and axial rotation pattern. As such, a sound knowledge of the basic principles of spine instrumentation and the region’s kinematics are essential when it comes to strategic preoperative planning. Skull-base, craniovertebral junction, spine demolitive and reconstructive surgery, neuromodulation, bioengineering and transplantation are recent tools used to improve reconstruction, restoration and rehabilitation – three key words central to the core aim of the Neurorehabilitation and Reconstruction Committee of the WFNS, which is to promte mechanical morphological and functional restoration.