Comprehensive Management of Skull Base Tumors by Ehab Y. Hanna Franco DeMonte

Author:Ehab Y. Hanna, Franco DeMonte
Language: eng
Format: epub, pdf
Publisher: Thieme
Published: 2021-03-15T00:00:00+00:00

19.7.1 Positioning

For open procedures, the patient is placed supine on the operating table and the head is turned to the side contralateral to the lesion. When intracranial neurovascular work is anticipated, the head may be fixed in a Mayfield headrest or in fixation pins. The patient’s body is secured with straps and carefully cushioned to avoid pressure points; this facilitates rotation of the entire table to enhance visualization. Hair is parted, clipped or shaved along the path of the planned incision, and the face, scalp and neck are prepped in sterile fashion.

For endoscopic approaches, the patient is positioned supine in the operating table with the head in neutral position. The head of the table is raised, in a reverse Trendelenburg position, to decrease central venous pressure. The nasal cavity is prepared with pledgets bearing topical decongestant. The eyes are lubricated but kept accessible for intraoperative monitoring of the pupils and globes. A 3D stereotactic navigation system, though not absolutely necessary, can aid in confirmation of landmarks and locations of structures at the skull base and can be helpful in defining trajectory and assessing completeness of resection. Navigation should be based on thin-cut CT images obtained immediately prior to surgery. The system is set up pri- or to the start of the case and calibrated using reliable external surface anatomy.

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