The history of skull base surgery dates back to the late 19th century. The evolution of surgical techniques has taken several leaps forward since its early days. The most important surgical breakthroughs occurred as the result of improved instruments.

The operating microscope was introduced in the United States for skull base surgery in the 1960’s and this allowed for far greater visualization of vital structures and reduction in morbidity. High speed drills were also introduced during this time which allowed for more precise surgical dissection.

The first hurdle to overcome in skull base surgery was safe removal of these tumors with reduction in mortality. At the turn of the 20th century, mortality was as high as 80 percent.

Technological advances have dramatically reduced mortality and reduction of surgical morbidity became the next goal. This has been achieved with advances in surgical approaches. The armamentarium of surgical approaches has been broadened over the years, some of which have been developed by neurosurgeons and some by neurotologists.

Team-Based Approach to Care

Another major advance that resulted in improved outcomes for skull base surgery was philosophical rather than technical. This was the introduction of the team approach concept for skull base surgery.

Forward-thinking skull base surgeons recognized early on that the surgical skill set necessary for the optimal care of these patients did not reside in one specialty. The neurotologists knew that their skills and training as an otolaryngologist were quite different than those possessed by neurosurgeons, and that both were needed for removal of tumors of the base of skull.

Partnerships with neurosurgeons were synergistic and allowed for remarkable contributions to the specialty of skull base surgery.

Progressive skull base programs have realized that one approach is not appropriate for all patients. The surgeries need to be individualized, which fosters the most beneficial collaborations between neurosurgeons and neurotologists.

Furthermore, these centers have realized that neurotologists and neurosurgeons have unique skills to offer in the aftercare of these patients. It has become clear that a team approach offers the optimal care for skull base patients.

Surgical and technological innovation has continued at a rapid pace and the team concept has broadened. The types of tumors managed by a skull base team have increased, and formerly poorly accessible areas of the skull base are now routinely operated on.

Stereotactic radiation therapy has also undergone a remarkable technological advancement. Outcomes data are outstanding for many types of tumors, and the skull base radiation oncologist is now an integral member of the team.