CRANIOFACIAL OSTEOTOMIES TO FACILITATE RESECTION OF LARGE TUMORS OF THE ANTERIOR SKULL BASE

Large tumours of the anterior cranial fossa can be a major challenge t o the neurosurgeon or the maxillofacial surgeon. However, skull base a pproaches facilitate their resection. We describe our experience with the extended subfrontal approach in treating tumours of the anterior c ranial base. This approach was performed on 29 patients with large rum ours of the anterior skull base. The final outcome in all 29 patients was favourable in terms of total resection of the tumour with minimal subsequent neurological deficit. Two patients developed transient oede ma of the frontal lobes without persistent neurological sequelae. Anot her patient developed a postoperative cerebrospinal fluid fistula that was successfully repaired. The patients were followed for a period ra nging from 6 to 28 months. There was no recurrence. The operative tech nique is described. En bloc removal of the roofs of the orbits and par t of the anterior cranial fossa permits wide exposure of the lesion wi th minimal brain retraction. Reconstruction of the anterior cranial ba se should be meticulous to avoid cerebrospinal fluid leaks and subsequ ent meningitis. Loss of smell is a sequel to this approach. The possib le risks and some important technical details are highlighted.