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J Neurol Surg B Skull Base 2023; 84(03): 201-209
DOI: 10.1055/a-1774-6281
Original Article

A Low Subfrontal Dural Opening for Operative Management of Anterior Skull Base Lesions

Samuel J. Cler 
1   Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
,
Gavin P. Dunn
1   Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
,
Gregory J. Zipfel
1   Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
,
Ralph G. Dacey
1   Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
,
Michael R. Chicoine 
1   Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
› Author Affiliations
Funding M.R.C. received funding from (1) IMRIS Inc. for an unrestricted educational grant to support an iMRI and brain tumor database and outcomes analysis project, the IMRIS Multicenter intraoperative MRI Neurosurgery Database (I-MiND), (2) the Head for the Cure Foundation, (3) Carol Rossfeld and The Alex & Alice Aboussie Family Charitable Foundation, and from (4) Barbara and George Holtzman. I-MiND maintained in The REDCap server at Washington University in St. Louis is supported by Clinical and Translational Science Award (CTSA) Grant [UL1 TR000448] and the Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842. R.G.D. is an investor in and member of the Board of Directors of Elira, Inc. This company manufactures a cutaneous neuro-stimulating device to suppress appetite and enhance weight loss and has a minor equity interest in the Neurolutions, Inc. and Pulse Therapeutics, Inc. G.P.D. is a co-founder of Immunovalent and a member of the Scientific Advisory Board of Ziopharm Oncology. None of these affiliations have a relationship to the current manuscript. G.J.Z. receives grant funding via the NIH National Institute of Neurological Disorders and Stroke (NINDS). S.C. received funding from NIH T35 NHLBI Training Grant Fellowship. The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.
› Further Information
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Abstract

Introduction A low subfrontal dural opening technique that limits brain manipulation was assessed in patients who underwent frontotemporal approaches for anterior fossa lesions.

Methods A retrospective review was performed for cases using a low subfrontal dural opening including characterization of demographics, lesion size and location, neurological and ophthalmological assessments, clinical course, and imaging findings.

Results A low subfrontal dural opening was performed in 23 patients (17F, 6M), median age of 53 years (range 23–81) with a median follow-up duration of 21.9 months (range 6.2–67.1). Lesions included 22 meningiomas (nine anterior clinoid, 12 tuberculum sellae, and one sphenoid wing), one unruptured internal carotid artery aneurysm clipped during a meningioma resection, and one optic nerve cavernous malformation. Maximal possible resection was achieved in all cases including gross total resection in 16/22 (72.7%), near total in 1/22 (4.5%), and subtotal in 5/22 (22.7%) in which tumor involvement of critical structures limited complete resection. Eighteen patients presented with vision loss; 11 (61%) improved postoperatively, three (17%) were stable, and four (22%) worsened. The mean ICU stay and time to discharge were 1.3 days (range 0–3) and 3.8 days (range 2–8).

Conclusion A low sub-frontal dural opening for approaches to the anterior fossa can be performed with minimal brain exposure, early visualization of the optico-carotid cistern for cerebrospinal fluid release, minimizing need for fixed brain retraction, and Sylvian fissure dissection. This technique can potentially reduce surgical risk and provide excellent exposure for anterior skull base lesions with favorable extent of resection, visual recovery, and complication rates.

Keywords

anterior fossa - skull base


Publication History

Received: 12 September 2021

Accepted: 14 February 2022

Accepted Manuscript online:
17 February 2022

Article published online:
03 May 2022

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