Perioperative Evaluation and Care of Patients with Lesions Involving the Skull Base

Within the past quarter of a century, contributions to the surgical literature have steadily reflected an increasing interest in the surgical extirpation of lesions involving the skull base. While optimistic reports demonstrate a variety of operative techniques1–9and clinical experiences,10–12there has been a paucity of discussion regarding the intraoperative and perioperative management of these complex cases. Cognizant of the fact that the care of these patients is of paramount importance, we herein review our rationale and practiced protocol for management of this unique patient population. The removal of lesions that also require the sacrifice of multiple cranial nerves results in significant postoperative morbidity. With the significant cardiopulmonary challenges attendant upon long procedures, these patients require constant multisystem management. Infection surveillance, wound care, cardiopulmonary support, fluid and nutritional monitoring, vocal and pharyngeal rehabilitation, along with psychological support, manifest in a complicated array of managerial decisions, require an organized approach to optimize patient care.