Celebrating the Golden Anniversary of Anterior Skull Base Surgery: Reflections on the Past 50 Years and its Historical Evolution

With its inception nearly half a century ago through the pioneering work of Dandy, McLean, and Smith, anterior skull base surgery is a relatively young discipline. It became a distinct entity in 1963 when Ketcham popularized the combined transcranial transfacial approach for en bloc resection of tumors of the paranasal sinus extending into the anterior cranial fossa. Since its inception, anterior craniofacial resection has been considered the gold standard for resection of anterior skull base tumors.

However, because these procedures resulted in major morbidities and mortalities, alternative modes of treatment were sought. Since the 1970s, the introduction and promotion of the surgical endoscope by Messerklinger, Stammberger, and Kennedy commenced the era of endoscopic sinus surgery. Thaler and colleagues described the utility of the endoscope for anterior skull base surgery at the turn of the 21st century. This allowed direct visualization and safer, more accurate removal of tumors.

The introduction of the endoscope in anterior skull base surgery has since propagated the formation of a collaborative effort between the neurosurgeon and otolaryngologist. In 2000, Casiano reported the first purely endoscopic endonasal anterior skull base resection, a novel technique that has been adopted by major skull base centers. The success of anterior skull base surgery can be attributed to both the development of the skull base team as well as improvements in surgical techniques, instrumentation, and visualization technology.

In this article, we review the historical evolution of anterior skull base surgery as we approach the 50th anniversary since its recognition as an individual discipline.