Vascular Challenges in Skull Base Surgery

Book excerpt: 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.