The Subcranial Approach to the Anterior Skull Base

Introduction: The purposes of this study are to present the technique of the extended subcranial approach to the anterior skull base and to review the results of 104 cases operated on for extirpation of tumors in this anatomical region.

Material and Methods: A retrospective review was conducted on the records of patients who underwent excision of tumors originating in the nasal cavity, paranasal sinuses, orbit, or meninges. The evaluation procedures, surgical technique, and complications were reviewed.

Results: Forty-eight cases involved malignant tumors and 56 involved benign tumors. The most common benign pathology was meningioma and the most common malignant tumor was squamous cell carcinoma. The principal skull base reconstruction procedure was performed using a multilayered fascia lata. Postoperative follow-up (26 months on average) revealed that 80% of the patients are without evidence of disease, 12% are alive with disease, 2% died of their disease, and 6% died of unrelated causes. The rate of severe complications was 4% and included meningitis (n = 2), cerebrospinal fluid rhinorrhea (n = 1), and tension pneumocephalus (n = 1).

Conclusions: We conclude that the extirpation of anterior skull base tumors via the subcranial approach is simple, reproducible, and reliable, and is associated with a reasonable complication rate.