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Aneurysm Surgery

In microsurgery for aneurysms, the exposure could be very limited due to swollen brain. After clipping the aneurysm, occasionally endoscope could be used to confirm completeness of clipping or rule out inclusion of any normal blood vessel in the clip.

In endoscope-assisted aneurysm surgery, the craniotomy, subarachnoid dissection, and cranial base osteotomy are generally performed in the usual manner. The use of the endoscope during clipping procedures includes three steps: initial inspection, clipping, and final inspection.

Skull Base Osteomyelitis (SBO)

Skull base osteomyelitis (SBO) is an infection of the temporal, sphenoid, or occipital bones that is typically caused by a complication of improperly treated otogenic or sinonasal infection in elderly patients with diabetes or immunocompromised patients. Generally, it presents with headaches, low grade fever and multiple cranial nerve weakness.

PET CT showing infective process (reddish)
Bone destruction

It is difficult to treat. The mainstay treatment for SBO includes a course of  long-term intravenous broad-spectrum antibiotic therapy.  In cases of widespread soft-tissue involvement, early aggressive surgical removal of infectious sequestra is required.