PRESERVATION OF OLFACTION IN ANTERIOR CRANIOFACIAL APPROACHES

Through the combined efforts of neurosurgeons, head and neck surgeons, and craniofacial surgeons, the standard transbasal approach to the fr ontal fossa has been modified to include removal of the orbital roofs, nasion, and ethmoid sinuses. This approach has been combined further with facial disassembly procedures to provide extensive midline exposu re to the midface and clival region. Extended frontal approaches, howe ver, necessitate removal of the crista galli and sectioning of the olf actory rootlets with the associated risk of anosmia, cerebrospinal flu id (CSF) leak, and the need for complex reconstruction of the frontal floor. To avoid these problems, the authors have modified the techniqu e of handling the cribriform plate to preserve the olfactory unit. Cir cumferential osteotomy cuts are made around the cribriform plate to al low an en bloc removal with its attachment to both the dura and underl ying mucosa. Opening of the dura is avoided and the cribriform bone is used to reconstruct the floor. Four patients underwent this approach, for treatment of an angiofibroma in three and a fibrosarcoma in one. The mean follow-up period was 7 months. No patients developed a CSF le ak, and within 8 weeks olfaction had returned in all patients. There w as no other associated morbidity. These data suggest that this modific ation of the transbasilar approach can alleviate extensive reconstruct ive procedures and CSF leaks while preserving olfaction.