What is the "Skull Base Surgery: Strategies"?
Skull Base Surgery: Strategies, edited by Walter C. Jean, is a 2019 Thieme reference focused on the strategic planning of skull base tumor surgery. It takes readers from clinical presentation and imaging through anatomical analysis, surgical goal setting, approach selection, and operative execution, using real-life cases and multiple surgical perspectives.
Introduction
Skull base surgery presents a distinctive challenge: the surgeon must work around complex anatomy while balancing tumor control against the preservation of neurological function and the patient's overall interests. In this setting, knowing individual surgical approaches is only part of the problem.
The more difficult question is often, "Which approach should be selected for a particular patient, and why?"
Skull Base Surgery: Strategies addresses this question directly.
Edited by Walter C. Jean, MD, Professor of Neurosurgery and Director of Skull Base Neurosurgery at George Washington University Hospital, the book was published by Thieme in 2019.
Its central educational concept is not simply to demonstrate what skull base surgeons do but to explain how they think, analyze imaging and anatomy, establish surgical goals, and design an operation around an individual patient.
The preface explains that the book was developed around a recurring question from students, residents, and colleagues examining skull base tumors on imaging: “How do we get there?” The authors approach this question by breaking skull base operations into component building blocks—such as the surgical corridor, craniotomy, and additional bone removal—and then teaching readers how these components can be combined according to the patient's anatomy and surgical objectives.
This makes the book particularly relevant to neurosurgical trainees and surgeons who want to develop a more analytical understanding of skull base approaches rather than simply memorizing named operations.
Book Overview
|
Detail |
Information from the book |
|
Full
title |
Skull Base Surgery: Strategies |
|
Editor |
Walter C. Jean, MD |
|
Publisher |
Thieme |
|
Publication
year |
2019 |
|
Format
identified in source |
Print book and e-book |
|
Print
ISBN |
978-1-62623-957-9 |
|
eISBN |
978-1-62623-958-6 |
|
Illustrations |
505 illustrations |
|
Primary
specialty |
Skull base surgery/neurosurgery |
|
Major
subject areas |
Skull base tumors, surgical
approaches, craniotomy methods |
|
Educational
structure |
Clinical cases,
anatomical/radiographic analysis, surgical strategy, operative approaches,
and Perspectives |
The cataloging information identifies the book's subject areas as skull base neoplasms and surgery and craniotomy methods.
It also identifies a large international contributor group representing neurosurgery, otolaryngology/head and neck surgery, radiology, and related disciplines. The contributors include specialists from institutions in North America, Europe, Asia, South America, and Australia.
WHAT THIS BOOK COVERS
The defining feature of Skull Base Surgery: Strategies is its organization around anatomical regions and surgical problems rather than a conventional disease-by-disease textbook structure.
The contents are divided into nine major parts.
Part I — Tumors of the Anterior Skull Base
The opening section covers the following:
- Tuberculum sellae
- Olfactory groove
- Nasopharynx and pterygopalatine fossa
These chapters introduce the book's approach to anterior skull base pathology and surgical corridors.
Part II — Tumors of the Anterolateral Skull Base
This section addresses the following:
- Anterior clinoid
- Juxtasellar cisterns
- Cavernous sinus
These locations require careful consideration of the relationships between tumors, skull base structures, cranial nerves, and major vascular structures.
Part III — Tumors of the Lateral Skull Base
The lateral skull base section includes:
- Meckel's cave
- Tentorial incisura
- Mesial temporal lobe
The organization emphasizes anatomical location as a major determinant of the operative strategy.
Part IV — Tumors of the Central Skull Base
The central skull base is covered through chapters on the following:
- Dorsum sellae
- Suprasellar region
- Posterior clinoid
Part V — Tumors Around the Clivus
This is one of the most extensive anatomical sections and includes:
- Petroclival region
- Spheno-caverno-petroclival region
- Petroclival fissure
- Foramen magnum
- Craniovertebral junction
Part VI — Tumors Around the Petrous Bone
The book then moves to:
- Petrotentorial junction
- Cerebellopontine angle
- Intracranial jugular foramen
- Intra- and extracranial jugular foramen
Part VII — Tumors of the Posterosuperior Skull Base
This section covers:
- Falcotentorial region
- Superior vermis
- Pineal region
Part VIII — Tumors of the Posteroinferior Skull Base
Topics include:
- Pontomesencephalic brainstem
- Pontomedullary brainstem
- Cerebellomedullary fissure
- Torcula
Part IX — Tumors of the Ventricles
The final major section addresses the following:
- Lateral ventricle at the foramen of Monro
- Lateral ventricular atrium
- Third ventricle
- Fourth ventricle
This broad anatomical coverage gives the book a distinctive progression from the anterior skull base through the central and lateral regions to the posterior skull base and ventricular system.
Key Features
Several features distinguish the educational approach of Skull Base Surgery: Strategies.
- Strategy-centered teaching: The book emphasizes how surgeons think and strategize rather than merely showing operative techniques.
- Real-life clinical cases: Chapters use patient cases rather than relying exclusively on generalized or theoretical discussions.
- Clinical-to-operative progression: The educational sequence moves from clinical presentation and imaging to anatomical interpretation, decision-making, and surgical execution.
- Patient-specific planning: The book teaches readers to tailor the operation to the individual patient and the surgical goal.
- Multiple surgical perspectives: Each chapter concludes with a perspective from another surgeon, deliberately presenting a different viewpoint.
- Standalone chapters: The editor states that each chapter is intended to function as a complete unit, reducing the need for constant cross-referencing.
- Extensive visual material: The title page identifies 505 illustrations.
- Supplementary video material: The source contains a dedicated video contents section covering numerous anatomical and operative approaches.
- International authorship: The acknowledgments describe contributions from surgeons around the world, including Japan, Italy, China, and Brazil.
Who Should Read This Book?
Neurosurgical residents and trainees
This is the audience most directly supported by the book's stated educational philosophy. The preface specifically describes questions arising from students, residents, and colleagues and emphasizes the importance of learning the analytical process behind operative design.
For residents, the value lies in learning to move beyond memorizing individual approaches toward understanding how anatomical findings, patient factors, and surgical objectives influence approach selection.
Skull base surgeons
Experienced surgeons may find value in the multiple perspectives presented throughout the book. The editor deliberately emphasizes that strategic decision-making does not always have a single correct solution and that different surgeons may approach the same problem differently.
Medical students
The book can provide an introduction to the conceptual framework of skull base surgery, particularly for students interested in neurosurgery. However, its highly specialized subject matter means that readers without a background in neuroanatomy and surgical principles may find some sections demanding.
Specialists and subspecialty learners
The contributor list demonstrates participation from neurosurgery, otolaryngology/head and neck surgery, radiology, and other relevant disciplines.
Researchers
The book contains bibliographic references and detailed discussions of surgical approaches and clinical cases. It is better characterized as a clinical and surgical educational reference.
Exam candidates
Its emphasis is on strategic surgical reasoning rather than rapid examination preparation. Therefore, its usefulness for exams is likely secondary to its role as a specialty reference, but a specific board-exam benefit cannot be confirmed.
Why This Book is Useful
1. It teaches surgical reasoning, not just surgical steps
Perhaps the book's most important contribution is its emphasis on decision-making.
The editor argues that teaching individual operative elements is necessary but insufficient. Surgeons must also understand how to combine those elements to construct an operation tailored to a particular patient and surgical goal.
That distinction is important in skull base surgery because anatomical variations and tumor relationships can make a standardized operation inappropriate for a particular patient.
2. It places the surgical goal before the operative plan
The introduction emphasizes that the overarching surgical goal should be established before designing the operation. Patient factors, anatomical factors, and surgeon factors then influence how that goal can be achieved.
The text provides examples in which a limited goal, such as brainstem decompression, may justify a less extensive operation than an approach designed for radical tumor resection.
3. It emphasizes patient-centered decision-making
The book repeatedly warns against allowing the pursuit of an ideal postoperative image to supersede the patient's interests.
One section explicitly argues that the surgical goal should be discussed with the patient and colleagues, including in a tumor-board setting, so that the surgeon understands what the patient hopes to gain and what risks the patient is prepared to accept.
4. It recognizes that surgical plans must adapt
The book does not present surgery as a rigid sequence that can always be followed unchanged. Its introduction explains that intraoperative events—such as vascular injury, changes in monitored brainstem potentials, or unexpected adherence to a cranial nerve—can require modification of the operative plan.
The important principle is to adapt the strategy while keeping the original surgical goal in view.
5. It demonstrates how anatomy affects approach selection
The chapters provide examples of how lesion size, location, pathology, ventricular anatomy, neurological status, hemispheric dominance, and surgeon familiarity can influence the choice of corridor.
This is particularly useful for understanding why apparently similar lesions may require different operative strategies.
Table of Contents Overview
The book contains 32 chapters, distributed across nine anatomical sections, followed by an index. The chapters progress from the anterior skull base to the anterolateral and lateral skull base, central skull base, clivus, petrous bone, posterior skull base, and finally the ventricles.
A particularly useful feature is the accompanying video content. It lists operative and anatomical videos covering procedures such as endoscopic endonasal approaches, anterior clinoidectomy, petrosectomy, anterior petrosectomy, supracerebellar transtentorial approaches, combined petrosal approaches, transclival approaches, jugular foramen approaches, far-lateral approaches, cerebellomedullary fissure approaches, and telovelar approaches to the fourth ventricle.
The combination of written case discussions, illustrations, and supplementary video content supports a multimodal approach to learning.
Strengths of the Book
Strategic rather than purely technical teaching
The book's central distinction is its attempt to explain the reasoning behind approach selection rather than simply documenting operative maneuvers.
Case-based education
The use of real clinical cases provides a context in which anatomical and surgical decisions can be understood.
Broad anatomical coverage
The 32 chapters encompass a large range of skull base and ventricular regions, making the book a substantial specialty reference.
Multiple expert viewpoints
The perspective sections deliberately introduce different surgical viewpoints rather than presenting every issue as having a single universally correct solution.
Strong visual component
The book contains 505 illustrations, and the source separately identifies numerous accompanying surgical and anatomical videos.
International contribution
The contributors represent a broad international group of specialists, supporting the book's stated aim of incorporating perspectives from surgeons working in different parts of the world.
Limitations
The source itself identifies a few characteristics that readers should understand before using the book.
First, the editor acknowledges that some minor repetition occurs between chapters, partly because each chapter is designed to stand alone and because different authors discuss similar concepts from different perspectives.
Second, the book's philosophy explicitly recognizes that skull base surgery does not always have one universally correct solution. Different surgeons may reach different decisions because of differences in training, experience, and previous outcomes. For readers seeking a rigid algorithm for every skull base tumor, this may require a different learning mindset.
Third, the subject matter is highly specialized. The source presents advanced surgical anatomy and operative strategies rather than a general introduction to neurological disease. This makes the book more naturally suited to readers with an existing foundation in anatomy, neurosurgery, or related specialties.
Comparison With Similar Books
The preface describes two broad types of existing skull base surgery books. According to the editor, some function primarily as atlases with detailed dissections but limited discussion of practical application, while others organize chapters around disease entities and provide generalized surgical approaches.
Skull Base Surgery: Strategies is deliberately presented as different because it focuses on both what surgeons do and how they think and strategize, using patient-specific clinical and radiographic findings to reach an operative plan.
Therefore, the most defensible distinction supported is that this book emphasizes strategic operative design and case-based decision-making, rather than functioning solely as an anatomical atlas or generalized disease-management textbook.
Skull Base Surgery: Strategies
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FAQs
Skull Base Surgery: Strategies is a Thieme surgical reference edited by Walter C. Jean. It focuses on the decision-making process involved in selecting and executing surgical approaches for skull base tumors, progressing from clinical presentation and imaging to anatomical analysis and operative strategy.
The book is particularly relevant to students, residents, colleagues, trainees, and surgeons interested in skull base surgery. Its educational approach is designed around understanding surgical strategy and the reasoning behind operative design.
The book was edited by Walter C. Jean, MD, professor of neurosurgery and director of skull base neurosurgery at George Washington University Hospital in Washington, DC.
The publication year is 2019, with Thieme as the publisher.
The contents list 32 numbered chapters, covering anatomical regions from the anterior skull base through the ventricles, followed by an index.
Yes. It contains a dedicated video content section listing numerous anatomical and operative videos, including endoscopic, transcranial, petrosal, transclival, far-lateral, and telovelar approaches.
According to the editor, the book goes beyond showing operative anatomy and surgical actions. It focuses on the reasoning process: assessing the patient, interpreting imaging and anatomy, establishing surgical goals, choosing an approach, and executing the operation.
No. Its philosophy is explicitly based on patient-specific decision-making. It states that strategic decision-making in skull base surgery does not necessarily produce one unique solution, and each chapter includes a different surgical perspective to reflect this variability.
Conclusion
Skull Base Surgery: Strategies is a specialized surgical reference built around an important principle: successful skull base surgery requires more than knowing individual approaches—it requires understanding how to select and combine them for a particular patient and a clearly defined surgical goal.
Edited by Walter C. Jean and published by Thieme in 2019, the book covers 32 chapters across nine major anatomical sections, ranging from the anterior skull base to the ventricles.
Its educational structure combines clinical cases, radiographic and anatomical analysis, operative strategy, surgical techniques, perspectives from additional surgeons, 505 illustrations, and a collection of supplementary videos.
Its greatest educational value lies in its emphasis on surgical reasoning. Rather than treating an operation as a predetermined recipe, the book encourages readers to consider patient factors, anatomical factors, surgical objectives, and the practical consequences of each component of an operative plan.
For neurosurgical residents, skull base trainees, and surgeons seeking to strengthen their understanding of operative strategy, Skull Base Surgery: Strategies offers a case-centered framework for thinking about some of the most anatomically demanding surgical problems.
The book is therefore best viewed not simply as a collection of skull base approaches but as a resource for learning how to think strategically about skull base surgery.
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