Early outcome and complications of the extended subcranial approach to theanterior skull base

Objectives: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who under went the procedure. Study Design: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior sk ull base between 1994 and 1998 for the treatment of various neoplasms origi nating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or menin ges, as well as for the repair of complex craniofacial trauma and/or cerebr ospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed, Methods: Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with sp ecial focus on early outcome and complications. Results: Twenty six patient s underwent oncologic resections, 22 patients had reduction of complex fron to-naso-orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensi ve intracerebral damage and multiorgan failure, and one patient had nontens ion pneumocephalus coupled with CSF leakage and one patient had temporary n ontension pneumocephalus. The most common late complication in all three gr oups was anosmia. Conclusions: Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various p athological conditions involving the anterior skull base.