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Skull base surgery in Tijuana
The floor of the skull is where the arteries and all twelve cranial nerves enter and leave. Operating there requires approaches designed to pass between them, not over them.
Why the skull base is its own chapter
Over the convexity the brain has room and the surgeon has margin. At the base it does not: within a few centimetres sit the carotid, the basilar trunk, the nerves that move the eye, the trigeminal, the facial, the auditory nerve and those controlling swallowing. A five-centimetre lesion there is a different problem from the same tumour elsewhere.
That is why skull base surgery is defined by its approaches: pterional, subtemporal, retrosigmoid, orbitozygomatic, transsphenoidal. Each opens a different corridor between structures that must not be touched, and choosing the right one is half the result.
Bone work so the brain is not retracted
The logic of these approaches is simple to state: remove more bone so you retract less brain. Drilling a sphenoid ridge or the petrous bone costs minutes in theatre, but turns a manoeuvre that once demanded lifting the temporal lobe into one performed with long instruments under the microscope, with no traction.
A good share of these lesions are benign — meningiomas, schwannomas, epidermoid cysts, chordomas — and the patient may live for decades with the result of the operation. When complete resection would cost a cranial nerve, a safe subtotal resection plus follow-up or radiosurgery is preferred. Function is kept; the remnant is watched.
What the procedure involves
When it is indicated
- Sphenoid wing, olfactory groove or clival meningioma
- Vestibular schwannoma and other cerebellopontine angle tumours
- Midline chordoma and chondrosarcoma
- Epidermoid cyst of the basal cisterns
- Neurovascular compression of the trigeminal or facial nerve
- Intracranial extension of paranasal sinus tumours
Techniques and resources
- High-speed drill
- Operating microscope
- Endoscope where available
- Cranial nerve monitoring
- Skull base CT angiography
- Fat graft and dural sealant
Frequently asked questions about skull base surgery
It is technically more demanding because the margin for error is smaller: critical structures sit millimetres away. That is offset by approaches that give direct vision, by the microscope, by monitoring, and above all by not forcing a total resection when the price would be a cranial nerve.
It is one of the possible risks when the lesion involves the trigeminal or facial nerve, and it is explained to you in writing before surgery. Intra-operative monitoring and microscopic dissection exist precisely to reduce it.
It is fluid escaping through the nose or the wound when the closure is not watertight. It is the classic complication of this surgery, which is why the base is sealed with duraplasty, fat or a flap, and watched over the first days.
Bring your imaging and settle the question
One consultation with your MRI or CT in hand is worth more than ten internet searches. Book by phone or through the form and you will be told what is there, what it means and what your options are.