Management of Central Skull Base Tumors

The cranial base is conventionally classified into anterior, middle and posterior parts that correspond to the respective cranial fossa. However, many pathologies straddle the middle and posterior skull base and can be considered under the region of central skull base (CSB). Though sporadic attempts at skull base surgery were made in the early 20th century, it was only in the 1960s that serious efforts of interdisciplinary cooperation among neurosurgeons, otorhinolaryngologists and maxillofacial surgeons were made to tackle skull base lesions [7]. The CSB, especially the cavernous sinus (CS) region was the last to be tackled directly. While Parkinson’s article describing the direct surgical attack on the cavernous sinus for the carotid-cavernous sinus fistula was the first of its kind, it was Dolenc’s extensive experience and his description of the combined epidural and subdural approach to the CSB that led many neurosurgeons to venture into cavernous sinus surgery [2]. In spite of the many advances and large experiences, debate still continues as to the best approach to the parasellar region — microsurgery, radiosurgery, combined modality or observation.