Name of the Procedure:

Resection or excision of neoplastic, vascular, or infectious lesion of the parasellar area, cavernous sinus, clivus, or midline skull base; extradural

Summary

This surgical procedure involves the removal of abnormal growths, such as tumors, blood vessel abnormalities, or infections, located in complex regions at the base of the skull. It is performed outside the dural covering of the brain.

Purpose

This procedure aims to treat conditions such as tumors, vascular malformations, or infections that affect critical areas at the base of the skull. The goal is to alleviate symptoms, prevent progression of disease, and improve quality of life by removing the lesion.

Indications

• Symptoms of compression or pressure on brain structures (e.g., headaches, vision problems, hormonal imbalances, facial pain)
• Neurological deficits associated with the lesion
• Confirmed diagnosis of a neoplastic, vascular, or infectious lesion in the parasellar area, cavernous sinus, clivus, or midline skull base

Preparation

• Fasting for a specified period before the procedure
• Medication review and adjustments, including cessation of blood thinners
• Pre-operative imaging studies (e.g., MRI, CT scans)
• Blood tests and other routine assessments

Procedure Description

1. The patient is positioned and an area of the scalp is shaved and cleansed.
2. Anesthesia is administered to ensure the patient is unconscious and pain-free.
3. A precise incision is made to access the base of the skull.
4. Specialized surgical instruments are used to carefully remove the lesion.
5. The surgical site is thoroughly examined to ensure complete removal.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity of the lesion.

Setting

Usually performed in the neurosurgery operating room of a hospital.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Possibly a radiologist for real-time imaging assistance

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding brain structures, nerves, and blood vessels
• Cerebrospinal fluid leaks
• Post-operative pain
• Scar tissue formation
• Rarely, stroke or death

Benefits

• Relief from symptoms caused by the lesion
• Prevention of further neurological deterioration
• Improvement in overall function and quality of life, often noticeable in weeks to months

Recovery

• Initial hospital stay for monitoring, typically several days
• Pain management with medications
• Instructions on wound care
• Gradual return to normal activities over 4 to 6 weeks
• Follow-up appointments with the surgeon for monitoring and additional imaging studies

Alternatives

• Observation with regular imaging and clinical monitoring for slow-growing or asymptomatic lesions
• Radiation therapy to shrink or control the growth of the lesion
• Minimally invasive approaches, if deemed appropriate by the medical team

Patient Experience

Patients may feel anxious before the procedure but will be under general anesthesia during the operation. Post-operatively, there may be discomfort at the incision site and some temporary neurological symptoms such as headaches or visual disturbances. Pain management will be provided, and care teams will work to ensure patient comfort and support during recovery.