Skull base lesions comprise a diverse group of benign and malignant pathologies arising from the bone, dura, cranial nerves, vascular structures, or adjacent soft tissues at the base of the brain. Their location in close proximity to critical neurovascular structures presents unique diagnostic and surgical challenges. Lesions may include meningiomas, pituitary region tumors, chordomas, schwannomas, and selected metastatic or inflammatory processes.

Clinical presentation depends on lesion location and pattern of neural involvement. Symptoms may include cranial nerve deficits, visual disturbance, hearing loss, facial numbness, swallowing difficulty, hormonal dysfunction, or headache. Progressive neurological impairment often prompts advanced imaging and neurosurgical referral.

Neurosurgical evaluation relies on high-resolution imaging to define lesion anatomy, vascular relationships, and surgical corridors. MRI with contrast is central to diagnosis, while CT aids in assessing bony involvement. Surgical planning prioritizes maximal lesion control with preservation of neurological function.

Surgical management of skull base lesions requires advanced microsurgical expertise and, in selected cases, endoscopic approaches. The choice of approach is dictated by lesion location, size, consistency, and relationship to critical structures. The principle of maximal safe resection is fundamental, balancing oncological control with functional preservation.

Intraoperative navigation, neurophysiological monitoring, and meticulous microsurgical technique are essential to minimize morbidity. Postoperative management focuses on neurological monitoring, management of cranial nerve deficits, and coordination of adjuvant therapy when indicated.

Skull base lesion surgery represents one of the most technically demanding areas of neurosurgery, requiring specialized expertise, careful planning, and long-term follow-up.