127 - Anterior cranial base surgery

Summary

Anterior cranial base surgery has been greatly enhanced with new advances in diagnostic and surgical techniques that apply a comprehensive, multidisciplinary methodology to the removal of anterior skull-base lesions. Approaching the anterior cranial base from anterior and below has gained increasing popularity because of the minimal amount of frontal lobe retraction. In addition, the technique eliminates the need for facial incisions, therefore avoiding facial scarring. In contradistinction to more traditional techniques that often ensure anosmia, the approach also allows for the preservation of smell depending on the location of the lesion.

Imaging plays an important role in the surgical and reconstructive planning of craniofacial tumors as it allows for assessment of the extent of the disease process and determination of the operability of the lesion. The imaging modalities commonly employed include axial and coronal two-dimensional, three-dimensional, and interactive three-dimensional CT imaging; MR imaging; and angiography.

The use of the subcranial approach in anterior cranial base surgery allows intracranial access extending along the posterior planum sphenoidal, anterior clinoid, and tuberculum sellae. The lateral aspect of the exposure is determined by the type and extent of craniotomy that is performed. Extra-cranial exposure extends to the foramen magnum. After tumor extirpation, closure is routinely accomplished with a pericranial flap. A tracheotomy is rarely necessary if nasal trumpets are placed to divert air away from the skull-base closure.

Anterior cranial base procedures are performed under general anesthesia. Depending on the extent of the disease process, the operative time may range from 3–10 hours.