•

Advances in oncologic and reconstructive surgery, anesthesiology, radiology, and other related fields have made surgery of the cranial base both technically feasible and therapeutically effective. As a result, surgical resection can be considered the primary management modality for many cranial base lesions previously considered inaccessible or inoperable.

•

Symptoms from anterior and middle cranial base lesions may range from headache to impaired cranial nerve and central nervous system functions. These disorders are insidious in that they cause few symptoms until they have reached advanced stages and impinge on cranial nerves, major vessels, or the brain. This paucity of early symptoms makes early diagnosis difficult.

•

Operative planning for the removal of lesions of this anatomically complex region requires that laboratory testing, imaging, and vascular interventional procedures be used to their fullest potential to guide the surgical and anesthetic teams, as well as the patient’s expectations.

•

Operative approaches should attempt to meet principal aims of (1) optimizing exposure, (2) preserving neurovascular structures, (3) implementing the use of image guidance and endoscope assistance to enhance the resection while limiting incision length and removal of normal tissue, and (4) planning surgical techniques that optimize functional and aesthetic reconstruction.

•

Postoperative complications may entail serious morbidity and mortality; limiting postoperative neurologic and other complications requires anticipation of potential risks and an aggressive approach to their prevention and management.