Black holes of the brain: how to reach challenging areas of the cerebrum.

Numerous techniques and tools can be used to access difficult areas of the cerebrum: skull base techniques, modern operating room equipment, and a unified team approach. Using these principles, challenging areas of the cerebrum can be approached with maximal success and minimal morbidity. These techniques are powerful tools in the armamentarium of neurosurgeons and can improve any neurosurgical approach. The basilar region remains one of the most difficult areas to approach. Despite its inherent complexity, lesions of the basilar region can be treated successfully. The far-lateral approach is used to access the lower two-fifths of the basilar region; the transcochlear approach is used to access the middle fifth of the basilar region; and the orbitozygomatic approach is used to access the upper two-fifths of the basilar region. Each approach beautifully exemplifies the principles of skull base surgery.