Neurosurgical otolarynology II: Endoscopic skull base and pituitary surgery

Successful endoscopic surgery of the skull base requires a rigorous understanding and comfort level with the surgical anatomy of the paranasal sinuses and adjacent vital structures including the orbit, optic nerve, carotid artery, cavernous sinus, and meninges. Since these structures are often protected by a thin barrier of mucosa-covered bone that may be violated by inflammation, neoplasm, or trauma, every case requires comprehensive presurgical imaging and planning. Anesthesiologists must also respect these unique anatomic relationships, as a surgery that is going well may quickly turn difficult in an area where the margin for error is small. Continued and effective communication between anesthesiology and surgical teams throughout the perioperative period helps ensure a safe and efficient surgical experience for the patient.