Advances in Approaches to the Cranial Base: Minimizing Morbidity

ABSTRACT

The most innovative and meaningful recent advances regarding surgery of the cranial base involve the ability to perform a complete resection followed by a water- and airtight reconstruction while minimizing facial incisions and morbidity. Perhaps the first step in this direction took place when the subcranial/subfrontal approach was introduced for anterior skull base surgery. Originally developed by Raveh in 1978 for the management of severe skull base injuries, these approaches were later adapted for the treatment of congenital anomalies prior to their utilization for resection of anterior skull base tumors. The endoscopic approaches are quite practical with promising long-term efficacy for the treatment of most benign, infectious, and inflammatory disorders. The minimal recovery time, functional outcomes, and obvious aesthetic advantages are only tempered by the lack of long-term data regarding the efficacy of these approaches in the treatment of malignancies.

Cranial base - skull base - minimally invasive approaches - endoscopic - craniofacial resection - subcranial approach

REFERENCES

• 1 Kassam A, Snyderman C H, Mintz A et al.. Expanded endonasal approach: the rostrocaudal axis. Part I Crista galli to the sella turcica.  Neurosurg Focus. 2005;  19 1-12
• 2 Draf W, Schick B, How I. Do it: endoscopic-microscopic anterior skull base reconstruction.  Skull Base. 2007;  17 59-72
• 3 Raveh J, Vuillemin T. The surgical one-stage management of combined cranio-maxillo-facial and frontobasal fractures. Advantages of the subcranial approach in 374 cases.  J Craniomaxillofac Surg. 1988;  16 160-172
• 4 Laedrach K, Annino D, Raveh J et al.. Advanced approaches to cranio-orbital injuries.  Facial Plast Surg Clin North Am. 1995;  3 107-129
• 5 Eloy J A, Shohet M R, Bederson J B et al.. Intracranial mucocele: an unusual complication of cerebrospinal fluid leakage repair with middle turbinate mucosal graft.  Otolaryngol Head Neck Surg. 2007;  137 350-352
• 6 Raveh J, Laedrach K, Vuillemin T. Craniofacial congenital anomalies: the subcranial approach. In: Bosniak S Principles and Practice of Ophthalmic Plastic and Reconstructive Surgery. Vol. 2. Philadelphia, PA; WB Saunders Company 1996: 1163-1177
• 7 Raveh J, Laedrach K, Speiser M et al.. The subcranial approach for fronto-orbital and anteroposterior skull base tumors.  Arch Otolaryngol Head Neck Surg. 1993;  119 385-393
• 8 Snyderman C H, Kassam A B, Carrau R C et al.. Endoscopic reconstruction of cranial base defects following endonasal skull base surgery.  Skull Base. 2007;  17 73-78
• 9 Day T A, Vuillemin T, Lädrach K et al.. Calvarial bone grafting in craniofacial reconstruction.  Facial Plast Surg Clin North Am. 1995;  3 241-255
• 10 Cheney M L, Varvares M A, Nadol Jr J B. The temporoparietal fascial flap in head and neck reconstruction.  Arch Otolaryngol Head Neck Surg. 1993;  119 618-623