EXTENDED ANTERIOR SUBCRANIAL APPROACH FOR SKULL BASE TUMORS - LONG-TERM RESULTS

The extended anterior subcranial approach differs significantly from m ore traditional surgical approaches to the skull base in that it allow s a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The autho rs initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies, I n 1980 they expanded the indications to include the combined neurosurg ical-otolaryngological resection of various skull base tumors. Osteoto my of the frontonasoorbital external skeletal frame provides optimum a nterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retracti on and the external facial incisions characteristic of transcranial an d transfacial approaches. The improved visualization of the anterior s kull base and clival-sphenoidal region facilitates en bloc tumor remov al, optic nerve decompression, exposure of the medial aspect of the ca vernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the pa st 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive ca re unit and overall hospital stay are reduced, related complications a re minimized, and postoperative cosmetic appearance is enhanced. The e xtended anterior subcranial method is therefore an excellent alternati ve to traditional transfacial-transcranial skull base approaches for t he removal of selected skull base tumors.