Combined Subcranial Approach: A Surgical Alternative for the Resection of Anterior Skull Base Tumors

Objective: This article aims to describe the outcome of patients with selected tumors encroaching the anterior skull base, utilizing combinations of the subcranial approach.

Patients and Methods: Retrospective study of 113 patients presenting with benign and malignant tumors encroaching the anterior skull base, treated in a single cancer center with combined subcranial approaches, in the period from 2000 to 2024. We aim to compare the results of this technique with the results of patients treated by the classic craniofacial technique, as well as, with data from the international literature. The surgical results, survival, and complications were measured.

Results: Of the 113 patients included in the study, most had a subcranial approach without facial incisions (72 patients—63%). The average duration of surgery was 7.45 hours. Patients spent an average of 2 days in the intensive care unit and 7 days hospitalized. The incidence of complications was 32%, with sinocutaneous fistula near the orbital region being the primary complication, occurring in 27% of cases. Additionally, 14% of patients developed liquoric fistula, managed conservatively without requiring surgical reintervention. There were no reported cases (0%) of meningoencephalitis or neurological complications. Adjusted 5-year overall survival was 58.2%. Complete tumor resection was achieved in all cases (100%).

Conclusion: This surgical approach offered reduced neurological and general complications, a tendency toward shorter surgical times, lower rates of blood transfusion, decreased intensive care unit and hospital stays, and feasibility for the resection of selected craniofacial tumors involving the anterior skull base. Depending on tumor size, the technique can be applied with or without facial access, with a preference for the latter in the majority of cases we manage.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025