12 Extended Endonasal Anterior Skull Base Approaches

Soma Subramaniam, Guillermo Maza, Daniel M. Prevedello, and Ricardo L. Carrau

Abstract

Open and expanded endoscopic endonasal approaches (EEAs) may be utilized for resection of anterior cranial fossa tumors based on the stage, histology, and patient’s specific needs and characteristics (i.e., body habitus, severe sleep apnea), as well as the surgical team’s training and preference. Traditional open craniofacial approaches require a craniotomy and maxillofacial osteotomies that may include those necessary for a subfrontal approach. Despite the development of minimal access approaches (endonasal, transorbital, and minicraniotomy), a subfrontal technique remains one of the primary strategies to manage anterior cranial base lesions, especially those with significant lateral or anterior extension or those involving critical neurovascular structures. Endoscopic, endoscopic-assisted, and open approaches afford advantages and disadvantages and have different indications and limitations; therefore, skull base surgeons and their teams must be versed in all techniques. However, the EEA has been increasingly applied for the resection of select anterior cranial base lesions. Benefits of EEAs include its enhanced visualization, the minimal manipulation of the brain (no retraction), avoidance of maxillofacial osteotomies, and lack of facial scars or cosmetic deficits. In this chapter, we will review all aspects of EEAs to the anterior cranial fossa. We include two case examples to illustrate how EEAs are used in two different scenarios.

Key words

expanded endonasal approach - reconstruction - anterior skull base - vascularized flap - craniofacial resection

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