OUTCOME ANALYSIS OF THE TRANSGLABELLAR SUBCRANIAL APPROACH FOR LESIONS OF THE ANTERIOR CRANIAL FOSSA - A COMPARISON WITH THE CLASSIC CRANIOTOMY APPROACH/

The classic approach to anterior skull base lesions uses bifrontal cra niotomies together with lateral rhinotomies. This approach requires fr ontal lobe retraction and is associated with postoperative anosmia and the development of frontal lobe encephalomalacia. The transglabellar/ subcranial approach permits removal of anterior skull base lesions wit hout frontal lobe retraction and avoids facial scars. No studies to da te, however, have directly compared the two approaches in terms of pat ient morbidity. The present retrospective study compares the two appro aches when used for the removal of anterior skull base lesions in term s of estimated blood loss, number of transfusions, number of days in t he hospital and intensive care unit, and postoperative complications. Twenty patients with anterior skull base lesions were examined. The cl assic approach was used on 10, and the transglabellar/subcranial route was used on 10. When compared with the classic approach, the transgla bellar/subcranial approach resulted in a lower estimated blood loss an d subsequent transfusion rate, fewer days in the hospital and intensiv e care unit, and lower numbers and less severe types of complications. Furthermore, visualization of the tumors before resection with the tr ansglabellar/subcranial approach allowed preservation of olfaction in virtually all of these patients. Although this study represents a smal l sample population, the results are sufficiently impressive to favor the transglabellar/subcranial approach for the removal of a variety of anterior skull base lesions.