Perioperative and intraoperative maneuvers to optimize surgical outcomes in skull base surgery

Daniel Timperley, Raymond Sacks, Richard J. Parkinson, Richard J. Harvey*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)


There are many approaches to obtaining a workable endoscopic surgical field in sinus surgery. With extended sinus and transdural endoscopic surgery, a more rigid approach must be taken. There are 3 main factors that invariably lead to poor surgical outcomes in endoscopic sinus and skull base surgery: bleeding, inadequate access, and unidentified anatomic anomalies. Bleeding is arguably the most common reason for incomplete resection. An understanding of microvascular and macrovascular bleeding allows a more structured approach to improve the surgical field in extended endoscopic surgery. The endoscopic surgeon should always be comfortable in performing the same procedure as an open operation. However, converting or abandoning an endoscopic procedure should rarely occur because much of this decision making should take place preoperatively. Along with poor hemostasis, inadequate access is an important cause of poor outcome. Evaluation of the anatomy involved by pathology but also the anatomy that must be removed to allow adequate exposure is important. This article reviews the current techniques used to ensure optimal surgical conditions and outcomes.

Original languageEnglish
Pages (from-to)699-730
Number of pages32
JournalOtolaryngologic Clinics of North America
Issue number4
Publication statusPublished - 2010
Externally publishedYes


  • Angiofibroma
  • Endoscopic
  • Inverted papilloma
  • JNA
  • Osteoma
  • Sinonasal
  • Skull base
  • Tumor


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