The Subcranial/Transglabellar Approach to the Anterior Skull Base and Paranasal Sinuses: Our Experience with 39 Cases

Objective: To describe our experience with the subcranial approach developed by Raveh. Study Design: Retrospective case series of 39 consecutive patients managed surgically with this approach at our institution since 2007. Patients: The mean age was 38 years (range, 1-71 years), with a mean follow-up of 17 months. A standard bicoronal approach was used in all cases. Whenever the drainage pathway and posterior wall were intact, the frontal sinus was reconstructed. If the sinus was isolated from the intracranial cavity, but there were any doubts that it would be functional, obliteration was performed with bone dust, demineralized bone matrix, and/or pericranial flap. Otherwise, the sinus was cranialized. This approach was used in 19 trauma cases with craniofacial fractures, 8 patients with late sequelae of trauma, 7 tumors, 3 complicated sinusitises, 1 spontaneous CSF leak, and 1 congenital encephalocele. Results: None of the patients died. Short-term complications related to approach were: two postoperative CSF leaks (one was later diagnosed of intracranial hypertension) and one case of meningitis with full recovery. Permanent anosmia was common in trauma patients with complex fractures and patients with tumors invading the olfactory grooves. Conclusions: This approach gives wide access to the anterior cranial base and clival-sphenoid region for the treatment of a variety of pathologies. Also, it allows an adequate water and airtight reconstruction with minimal brain retraction.