An Extended Frontal Approach to Midline Lesions of the Anterior Skull Base

ABSTRACT

Relatively huge lesions in the parasellar and midline anterior skull base region are difficult to approach for radical procedures. To minimize brain retraction and achieve excellent exposure for safe manipulation within these regions, the authors have performed an extended frontal approach, a fibrontal craniotomy and a bilateral orbitofrontal osteotomy in 11 patients, and an additional transfacial maxillotomy in 1 patient. An additional removal of the orbital rim offers excellent visualization and permits unhindered surgical manipulation including postoperative reconstruction at the anterior skull base. But disadvantages include prolonged operative time and frequent ilateral olfactory denervation. Six patients with benign tumors, two patients with malignant tumors, one patient with hematoma in the ehtmoid and sphenoid sinuses, and three patients with delayed traumatic CSF rhinorheas were operated on using this approaches, with good results. The operative technique and its results are detailed.