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Skull Base Imaging in the Era of Minimal Access Surgery
Skull Base Imaging
P re f a c e S k u l l B a s e Im a g i n g i n t h e Er a of Minimal Access Surgery
Nafi Aygun, MD Editor
Radiol Clin N Am 55 (2017) xiii http://dx.doi.org/10.1016/j.rcl.2016.10.009 0033-8389/17/Ó 2016 Published by Elsevier Inc.
is now essential for radiologists to tailor their reads according to the needs of the surgeon. The first article of this issue provides a comprehensive review of surgical approaches. The second article highlights the importance of highresolution imaging in surgical planning and how high-resolution imaging is reshaping our understanding of anatomy and pathology at the skull base. The following articles, organized based on clinical symptoms and/or scenarios, address lesion detection and characterization using conventional and advanced imaging techniques. One article in this issue covers vascular lesions and their treatment by endovascular means. Cerebrospinal fluid leaks, more common in the era of minimally invasive surgery, are addressed in another article. I thank all the authors for their outstanding contributions, and I hope that you find the issue as interesting, comprehensive, and educational as it is practical. Nafi Aygun, MD Division of Neuroradiology Russel H. Morgan Department of Radiology Johns Hopkins University School of Medicine 600 North Wolfe Street Phipps B112B Baltimore, MD 21287, USA E-mail address: [email protected]
radiologic.theclinics.com
Ancient Egyptians who extracted the brain through the nose in the process of embalming are to be credited for laying the path for the twentieth century surgeons who used endoscopes to explore the possibilities of surgical treatment of sinonasal pathologies. This is followed by the development of techniques to access the sella turcica via the transnasal route. By the 1990s, transsphenoidal resection of pituitary tumors using endoscope was the standard of care. Experience gained in endoscopic sinonasal and transphenoidal pituitary surgery provided the vision for the expanded endonasal approaches to the skull base pathology. Fueled by the fascinating advances in optical and intraoperative navigational techniques, miniaturization of surgical instruments and radiologic imaging, minimal access skull base surgery is today pushing the limits of resectability while simultaneously decreasing morbidity. Many otolaryngology and neurosurgery training programs are now offering dedicated skull base surgery fellowships that herald the spread of these techniques from academic centers to community practices in the next decade. The role of the radiologist is also being redefined in the era of minimal access skull base surgery. In addition to the traditional radiologic approach that is mostly concerned about delineating the extent and nature of pathology, we are now asked to address issues related to access and safety. Having at least a basic understanding of potential access routes and hazards
P re f a c e S k u l l B a s e Im a g i n g i n t h e Er a of Minimal Access Surgery
Nafi Aygun, MD Editor
Radiol Clin N Am 55 (2017) xiii http://dx.doi.org/10.1016/j.rcl.2016.10.009 0033-8389/17/Ó 2016 Published by Elsevier Inc.
is now essential for radiologists to tailor their reads according to the needs of the surgeon. The first article of this issue provides a comprehensive review of surgical approaches. The second article highlights the importance of highresolution imaging in surgical planning and how high-resolution imaging is reshaping our understanding of anatomy and pathology at the skull base. The following articles, organized based on clinical symptoms and/or scenarios, address lesion detection and characterization using conventional and advanced imaging techniques. One article in this issue covers vascular lesions and their treatment by endovascular means. Cerebrospinal fluid leaks, more common in the era of minimally invasive surgery, are addressed in another article. I thank all the authors for their outstanding contributions, and I hope that you find the issue as interesting, comprehensive, and educational as it is practical. Nafi Aygun, MD Division of Neuroradiology Russel H. Morgan Department of Radiology Johns Hopkins University School of Medicine 600 North Wolfe Street Phipps B112B Baltimore, MD 21287, USA E-mail address: [email protected]
radiologic.theclinics.com
Ancient Egyptians who extracted the brain through the nose in the process of embalming are to be credited for laying the path for the twentieth century surgeons who used endoscopes to explore the possibilities of surgical treatment of sinonasal pathologies. This is followed by the development of techniques to access the sella turcica via the transnasal route. By the 1990s, transsphenoidal resection of pituitary tumors using endoscope was the standard of care. Experience gained in endoscopic sinonasal and transphenoidal pituitary surgery provided the vision for the expanded endonasal approaches to the skull base pathology. Fueled by the fascinating advances in optical and intraoperative navigational techniques, miniaturization of surgical instruments and radiologic imaging, minimal access skull base surgery is today pushing the limits of resectability while simultaneously decreasing morbidity. Many otolaryngology and neurosurgery training programs are now offering dedicated skull base surgery fellowships that herald the spread of these techniques from academic centers to community practices in the next decade. The role of the radiologist is also being redefined in the era of minimal access skull base surgery. In addition to the traditional radiologic approach that is mostly concerned about delineating the extent and nature of pathology, we are now asked to address issues related to access and safety. Having at least a basic understanding of potential access routes and hazards