The subcranial approach for anterior skull base tumors

Objective: To present the technique of the extended subcranial approach to the anterior skull base, and to review the results in 55 patients. Methods: A retrospective review was conducted on the records of 55 patients who underwent this procedure for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit or méninges, in an academic tertiary referral medical center. Preoperative patient evaluation, the surgical technique and complications are also reviewed; 21 patients had malignant tumors and 34 patients had benign tumors. Results: There was one perioperative death (fulminant meningitis at postoperative day 28). Significant complications consisted of meningitis occurring in two patients and five cases of osteoradionecrosis with bone cutaneous fistula. The most common late complication was anosmia (31 patients). Conclusions: Based on this review, we feel that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of tumors involving the anterior skull base.