Today, the specialized field of skull-base surgery is achieving remarkable results in treating tumors in hard-to-reach areas of the brain. Advances in diagnostic imaging, surgical techniques and instruments, and a better understanding of the skull-base anatomy allow neurosurgeons like Miguel A. Melgar, M.D., Ph.D., assistant professor and chief of Skull Base and Cerebrovascular Surgery in the UA College of Medicine, to remove these tumors -- while dramatically reducing the risks.

"Skull-base surgery refers to techniques required to obtain access to the small recesses of the undersurface of the brain," Dr. Melgar explains. "To reach that area of the brain, surgeons must be able to disassemble the skull, then put it back together."

Because skull-base surgery is a relatively new field, only a few neurosurgeons in the world are specially trained and qualified to perform this intricate surgery. With the help of a grant from Medtronics/Midas Rex, Dr. Melgar is developing a skull-base surgery laboratory to train physicians in skull-base neurosurgical skills.

"At UMC we use intraoperative navigational tools such as the Stealth Station, that give us constant feedback as to how close we are to vital structures such as the optic nerve and the carotid artery, in relation to the tumor boundaries," he says.

The operation requires that bone surrounding the brain be removed, so the tumor can be taken out without having to "lift up" the brain and without disturbing the function of the nerves passing to the eyes, face, ears or throat. The neurosurgeon often works in conjunction with other specialists, such as ear, nose and throat or plastic surgeons, when performing skull-base surgery because of the close proximity of the face and neck to the skull base, Dr. Melgar says.

This type of surgery is one of the most challenging procedures for a neurosurgeon to perform, he adds. The challenge is not only in skill, but also in stamina because skull-base surgery can take as long as 15 to 20 hours to perform.

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