There are different structures that can be easily injured by operating on the skull base.

It is very important for the neurosurgeon to choose the right approach in order to reach the lesion without harming the other intact structures.

Various Approaches for Skull Base Surgeries:

1)Pterional Approach: The Pterional Approach is an anterolateral approach to the skull base. Its tremendous versatility makes it appropriate for most neuro-vascular pathologies, lesions involving the anterior and middle skull bases, as well as some intra-axial forebrain tumours.

2) Fronto-Temporal Approach: The fronto-temporal approach, adopted for most tumours, enables the nearest approach to the suprasellar region as well as optimal visualisation of the anatomical structures.

3) Trans-Sphenoidal Approach: Trans-Sphenoidal approach literally means “through the sphenoid sinus.” It is a surgery performed through the nose and sphenoid sinus to remove pituitary tumours. Trans-sphenoidal surgery can be performed either using an endoscope or a microscope, or at times using both.

4) Sub-Occipital Approach: The sub-occipital approach with a lateral arched skin incision is the simplest and least invasive surgical treatment for cerebrovascular lesions involving the vertebral and lower basilar arteries. It is commonly selected for lesions in the central part of one cerebellar hemisphere and in the brainstem.

These approaches can be extended and combined with each other.

Since every case is unique, the neurosurgeon will be able to explain the reason for the relevance of the approach in each case.