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Lessons Learned

Last Updated: June 26, 2019

Figure 1: Walter Dandy demonstrated his stepwise technique for resection of acoustic neuromas: 1) relief of intracranial tension through the use of ventriculostomy, 2) further cerebrospinal fluid drainage through the cisterna magna upon dural opening, and 3) final exposure of the tumor via resection of the lateral cerebellum (Dandy WE. The Brain. Hagerstown, MD: WF Prior Company, 1966).

Surgery of the cranial base is a technically demanding task that requires strict attention to detail. Operative experience plays an important role in maturation of a skull base surgeon. I have summarized my personal lessons over a decade of practice in this chapter.

Skull Base Osteotomy and Brain Mobilization

Extensive bony removal often requires large soft tissue scalp flaps. Incisions should be plann...