Surgical Access to the Base of the Skull through the Frontal Sinus

Introduction: The application of microsurgical techniques to the treatment of several types of pathologies involving the skull base has a fundamental role in improving postoperative results. Diseases of the cranial base may promote various symptoms, due to the extensive area in which it is anatomically.

Objectives: The study aims to discuss the most appropriate surgical approach to tumors of the skull base.

Resumed Report: A 49-year-old female patient, previously healthy, had started presenting headache, cognitive alteration, and decreased muscle tone from past 8 months. About 4 months ago, she developed hydrocephalus and intracranial hypertension. Brain magnetic resonance imaging revealed intraventricular lesion with nodular foci of contrast uptake and liquorice spread with hypothesis ependymoma. Surgical procedure was indicated for tumor biopsy and treatment guidance. In this case, the surgical approach was external, via frontal sinus, in which, after opening the dura, the tumor, nerve, and optic chiasm were visualized through the endoscope. The procedure was performed with a combined approach of teams neurosurgery and otolaryngology.

Conclusion: Most tumors in the skull base can be accessed via transsphenoidal, with the aid of the endoscope, we observed an atypical case in our service, which was best accessed via frontal sinus. This draws our attention to the multidisciplinary assessment of cases to choose the best surgical approach.