The extended transbasal approach: Clinical applications and complications

Objectives. To describe in detail key technical aspects of the extended tra nsbasal approach which involves en-bloc mobilisation of the supraorbital ri m, the orbital roof and the nasoethmoidal complex. In some patients osteoto mies were performed around the cribriform plate with a view to maintaining olfaction. To review 18 patients with deep seated lesions located in the central skull base region (including 6 recurrences) to highlight patient selection, pres entation, surgical morbidity and outcome., Methods. Prospective data recording and clinical chart review. Results. Outcome was assessed at a minimum of 1 year after operation using the Glasgow Outcome Score. Thirteen patients had made a good recovery, 1 wa s moderately disabled, 2 were severely disabled (both had been severely dis abled before operation), and 2 died. By contrast, quality of life assessmen t indicated that only 7 of the surviving 14 adults had returned to normal l evels of activity and perceived health, although 6 of the other 7 patients had resumed their former occupations, their follow up assessments showed a reduced quality of life. Of the 13 patients who had an olfaction preservati on procedure, 6 showed appreciation of smell on formal testing. Conclusions. In patients with progressive and extensive deep seated lesions this technique provides wide exposure in a shallow surgical field. Complic ation rates although acceptable were significantly higher in patients with intradural lesions. In some selected patients it was possible to preserve o lfaction. Specific surgical outcome assessments pointed to satisfactory res ults, but failed to reflect the degree of patient disability. There is a ne ed for outcome measures that take into account the patient's expectations a nd which address his quality of life in order to validate the benefit of th ese procedures.