The Subcranial Approach for Fronto-Orbital and Anteroposterior Skull-Base Tumors

TLDR

The subcranial approach, originally developed in 1978 for skull‑base trauma and craniofacial anomalies, has been expanded since 1980 to treat fronto‑orbital and sphenoethmoidal tumors, providing extended exposure that avoids frontal lobe retraction compared to conventional transcranial techniques. In a series of 78 patients, the subcranial approach offers extended anterior fossa exposure—including sphenoidal and clival planes—to enable en bloc tumor removal without the need for transfrontal or lateral rhinotomy. This technique reduces complications such as cerebrospinal fluid leaks, brain edema, cranial nerve injury, infection, and shortens hospitalization. Published in Arch Otolaryngol Head Neck Surg.

Abstract

• We describe 78 patients with fronto-orbital and sphenoethmoidal tumors surgically treated with the subcranial approach. This approach was developed by us in 1978 primarily for the treatment of skull-base trauma and craniofacial anomalies. Since 1980, we have extended the indications to include tumor resections. This extended anterior exposure of the anterior fossa skull base, including the sphenoidal and clival planes, enables an en bloc tumor removal obviating the transfrontal approach or lateral rhinotomy. In contrast with the conventional transcranial approach, the anterior subcranial approach provides an extended exposure of these locations, avoiding frontal lobe retraction. Reduction of complications, such as recurrent cerebrospinal fluid leaks, postoperative brain edema, damage to cranial nerves, and infection plus decreased hospitalization, are the major advantages of this procedure. (<i>Arch Otolaryngol Head Neck Surg.</i>1993;119:385-393)