Anterior skull base surgery using a limited approach

In the late 1970s, the skull base cases presented to us were post-surgical and post-irradiation. From congenital craniofacial deformity corrections, the complications of anterior cranial fossa dead space were understood. Because of this the limited anterior cranial fossa approach was developed and published in a series of articles from 1982 onward. The technique consisted of a limited trephine in the frontal bone with total removal of the frontonasal complex and nasal septum as necessary. Excellent exposure to the anterior cranial fossa was obtained. Just as important was an understanding of using vascularized tissue in the reconstruction of the anterior cranial base to seal off the cribriform area when indicated. Bony reconstruction was not necessary. This was also adapted for trauma and deformity corrections when indicated. In over 300 cases of anterior skull base tumors, malignant and nonmalignant, there have been 3 dead space problems requiring free tissue transfer and 1 cerebrospinal fluid leak requiring repair. The advantages of this approach, etc., will be further discussed.