Skull Base 2008; 18(4): 229-241
DOI: 10.1055/s-2007-1003924

© Thieme Medical Publishers

Low Complication Rates of Cranial and Craniofacial Approaches to Midline Anterior Skull Base Lesions

James T. Kryzanski1 , Donald J. Annino2  Jr. , Harsha Gopal3 , Carl B. Heilman1
  • 1Department of Neurosurgery, Tufts New England Medical Center, Boston, Massachusetts
  • 2Department of Otorhinolaryngology, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Division of Otolaryngology, Beth Israel-Deaconess Medical Center, Chestnut Hill, Massachusetts
Further Information

Publication History

Publication Date:
14 December 2007 (online)


Objective: Surgery is a cornerstone of treatment for a wide variety of neoplastic, congenital, traumatic, and inflammatory lesions involving the midline anterior skull base and may result in a significant anterior skull base defect requiring reconstruction. This study is a retrospective analysis of the reconstruction techniques and complications seen in a series of 58 consecutive patients with midline anterior skull base pathology treated with craniotomy or a craniofacial approach. The complication rates in this series are compared with other retrospective series and specific techniques that may reduce complications are then discussed. Design: This is a retrospective analysis of 58 consecutive patients who had surgery for a midline anterior skull base lesion between January 1994 and July 2003. Data were collected regarding pathology, surgical approach, reconstruction technique, and complications. Results: Twenty-nine patients underwent surgery for a meningioma (50%). The remainder had frontoethmoidal cancer, mucoceles/invasive nasal polyps, encephalocele, esthesioneuroblastoma, anterior falx dermoid cyst with a nasal sinus tract, or invasive pituitary adenoma. In most patients, a low and narrow two-piece biorbitofrontal craniotomy was used. When possible, the dura was repaired before entering the nasal cavity. Thirteen patients experienced a complication (22%). There was one case of postoperative cerebrospinal fluid (CSF) leak (2%), one case of meningitis (2%), two cases of bone flap infection (3%), and two cases of symptomatic pneumocephalus (3%). There were no deaths, no reoperations for CSF leak, and no patient had a new permanent neurologic deficit other than anosmia. Conclusions: Transcranial approaches for midline anterior skull base lesions can be performed safely with a low incidence of postoperative CSF leak, meningitis, bone flap infection, and symptomatic pneumocephalus. Our results, particularly with regard to CSF leakage, compare favorably with other retrospective series.


James T KryzanskiM.D. 

Department of Neurosurgery, Tufts New England Medical Center

750 Washington Street, Boston, MA 02111