Lessons Learned

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 planned with conservation of the blood supply and vascular pedicle in mind to avoid tissue ischemia and postoperative wound breakdown. Previous incisions, the potential need for any future incisions, and t...

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