A REVIEW OF SURGICAL APPROACHES TO THE ANTERIOR SKULL BASE – WITH CASE ILLUSTRATIONS

Abstract

The anterior skull base is home to a wide range of pathology that are either intracranial, sinonasal or orbital. Common intracranial pathologies encountered in our setting include Olfactory groove meningiomas, Planumsphenoidalemeningiomas, Tuberculum sellaemeningiomas, Optic pathway gliomas and abscesses. These lesions pose a surgical challenge due to their intricate proximity to various critical structures such as the olfactory tracts, orbit, optic nerve, chiasm, and the circle of wills. The choice of surgical approach is key and is dependent on many factors such as the location of the tumor, experience of the surgeon, and the type of lesion. The surgical approach chosen is also a key determinant of the extent of resection of the tumor and the postoperative morbidity of the patient. This paper reviews the surgical anatomy of the anterior cranial fossa and then discusses the Subfrontal, Interhemispheric, Pterional and Transbasal approaches using four illustrated cases that the authors have operated on. The case of a recurrent Olfactory groove meningioma with persistent cerebrospinal fluid leak is then used to illustrate the various techniques for reconstruction of the anterior skull base and the role of a multidisciplinary team in the management of anterior skull base lesions.