10.14639/0392-100X-N2226
text/xml
1827-675X
2226
en
Antonio Mazzoni
http://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
endoscopic approaches to the skull base
Surgery of the skull base as a new section in Acta Otorhinolaryngologica Italica
Text.Serial.Journal
https://www.actaitalica.it/
42
Letters to the Editor-in-Chief
2022-09-30
2022-07-15
2022-10-12
2022-10-12
400-401
1
Antonio Mazzoni
2022/09/30
10.14639/0392-100X-N2226
400
Department of Otolaryngology, Neurosciences Dept. University Hospital of Padova, Padova, Italy; Formerly Otolaryngology Department, Neurosciences Dept., Ospedali Riuniti, Bergamo, Italy
1827-675X
endoscopic approaches to the skull base
en
401
Surgery of the skull base as a new section in Acta Otorhinolaryngologica Italica
https://www.actaitalica.it/article/download/2226/861
42
ACTA OTORHINOLARYNGOLOGICA ITALICA 2022;42:400-401; doi: 10.14639/0392-100X-N2226




Letter to the Editor


Surgery of the skull base as a new section
in Acta Otorhinolaryngologica Italica
La chirurgia della base del cranio in una nuova sezione di Acta Otorhinolaryngologica
Italica
Antonio Mazzoni
Department of Otolaryngology, Neurosciences Dept. University Hospital of Padova, Padova, Italy; Formerly Otolaryngology
Department, Neurosciences Dept., Ospedali Riuniti, Bergamo, Italy


KEY WORDS: skull base surgery, skull base tumour, skull base approaches, microsurgery
of the skull base, endoscopic approaches to the skull base
PAROLE CHIAVE: chirurgia della base del cranio, tumori della base del cranio, approcci
alla base del cranio, microchirurgia della base del cranio, approcci endoscopici alla base
del cranio


Dear Editor,
The awareness of diseases and surgery of the skull base began in the 1960s
with meetings of experts and reports in the literature. The fundamental papers
by House 1,2, and Fisch 3-5 on skull base surgery appeared between 1961 and
1978 in the otological community, while the term appeared in the Acta Italica
(Archivio Italiano ORL) in 1974 6.
Surgery of the skull base went through a quick and brilliant development,
otologists and neurosurgeons promptly adopted the basic principles of skull
base approaches. The literature of the last quarter of the century was rich
with original and innovative contributions 7-10 and continued to the present
times when surgery of the skull base seems to have achieved its full degree of
maturity.                                                                                    Received: July 15, 2022
                                                                                             Accepted: July 26, 2022
The key of skull base surgery is that it extends the room for surgical maneuvers
to the skull base itself, beyond the traditional boundaries of the neck and                  Correspondence
endocranium. It is directed to lesions lying in the base, or the bony diaphragm              Antonio Mazzoni
separating the endocranium from neck and face, but also to adjacent areas,                   via Valverde 33, 24133 Bergamo, Italy
either endo- or esocranial, which can be better exposed if the skull base is part            E-mail: antonio.mazzoni@libero.it

of a new or conventional approach. In malignancies, this principle involves
enlargement of resection in safe tissues and is becoming part of modern                        How to cite this article: Mazzoni A.
                                                                                               Surgery of the skull base as a new section
oncological surgery.                                                                           in Acta Otorhinolaryngologica Italica. Acta
It often combines techniques belonging to different specialties and can involve                Otorhinolaryngol Ital 2022;42:400-401. https://
the collaboration of two or more specialists or a single surgeon mastering the                 doi.org/10.14639/0392-100X-N2226
different techniques.
                                                                                             © Società Italiana di Otorinolaringoiatria
This surgery is mostly microsurgery and includes the microscope and the more                 e Chirurgia Cervico-Facciale
recent endoscope and exoscope. The microscope and, to a similar extent the
exoscope, works at distance through a cone shaped access with a large entry                                 OPEN ACCESS
gate to a small target, achieving various angles of view and bimanual manoeu-                This is an open access article distributed in accordance with
                                                                                             the CC-BY-NC-ND (Creative Commons Attribution-Non-
vers. The endoscope adopts a small entry gate with progressive enlargement                   Commercial-NoDerivatives 4.0 International) license. The
and offers angled optics to bypass obstacles.                                                article can be used by giving appropriate credit and mentio-
                                                                                             ning the license, but only for non-commercial purposes and
Skull base surgery can treat a large number of primary diseases (chondrosar-                 only in the original version. For further information: https://
coma, chordoma, paraganglioma, meningioma, haemangioma, schwannoma,                          creativecommons.org/licenses/by-nc-nd/4.0/deed.en




400
                                                                                                                         Skull base surgery




and other benign and low-grade malignant tumours, sino-na-       funding agencies in the public, commercial, or not-for-
sal tumours), and their management is often a debated issue.     profit sectors.
The treatment of temporal bone primary malignant tumours
still involves insufficient information of growth modalities
                                                                 References
and, in individual cases, of tumour extent. Preservation of
function and cure of the disease is also an issue in the man-
                                                                 1
                                                                      House WF. Surgical exposure of the internal auditory canal
                                                                      and its content through the middle cranial fossa. Laryngoscope
agement of vestibular schwannoma and jugular foramen par-             1961;71:1363-1385.
aganglioma, where different options can be offered. Moreo-       2
                                                                      House WF. Transtemporal bone microsurgical removal of acoustic
ver, skull base surgery can control perineural infiltration of        neuromas. Arch Otolaryngol 1964;80:601-750.
head neck malignancies and of tumours arising intradurally       3
                                                                      Fisch U. Infratemporal fossa approach to lesions in the temporal bone
in the endocranium crossing the skull base to the esocranial          and base of the skull. Arch Otolaryngol 1979;105:99-107. https://
compartment, and vice versa.                                          doi.org/10.1001/archotol.1979.00790140045008
Today, education is a prominent issue facing skull base          4
                                                                      Fisch U, Mattox D. Microsurgery of the skull base. Stuttgard/New
surgery to provide the improvement that the specialty                 York: Georg Thieme; 1988.
deserves. It deals with the formal teaching in academic
                                                                 5
                                                                      Fisch U, Valavanis A, Yasargii MG. Neurological surgery of the ear
                                                                      and the skull base. Amsterdam: Kugler; 1989.
centres, the simultaneous training of the surgeon and the        6
                                                                      Mazzoni A. Jugulo-petrosectomy. Arch Ital Otol Rinol Laryngol
need for dedicated centres.                                           1974;2:20-25.
In conclusion, I am convinced that this still growing            7
                                                                      Derome PJ. The transoral approach to tumors invading the base of the
super subspecialty, entrusted to a few hub centres and                skull. In Schmidek HN, Sweet WH, editors. Operative neurosurgical
several skilled individual surgeons, as well as to the                techniques. New York: Grune and Stratton; 1982. p. 357-375.
scientific community, is ready to receive the favoured and       8
                                                                      Crockard HA. The transoral approach to the base of the brain and
authoritative attention of our journal.                               upper cervical cord. Ann Roy Coll Surg Engl 1985;67:321-325.
                                                                 9
                                                                      Snyderman CH, Carrau RL, Kassam AB, et al. Endoscopic skull base
Conflict of interest statement                                        surgery: principles of endonasal oncological surgery. Surg Oncol
                                                                      2008;15;97:658-664. https://doi.org/10.1002/jso.21020
The author declares no conflict of interest.                     10
                                                                      Stammberger H, Posawetz W. Functional endoscopic sinus surgery.
                                                                      Concept, indications and results of the Messerklinger technique. Eur
Funding                                                               Arch Otorhinolaryngol 1990;247:63-76. https://doi.org/10.1007/
This research did not receive any specific grant from                 BF00183169




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