Extended transbasal approach to skull base tumors: Technical nuances and review of the literature

A variety of novel surgical approaches have been developed in recent years to manage disease of the cranial base. Few offer the width and depth of exposure achievable with the extended transbasal approach. This approach combines a bifrontal craniotomy with an orbitonasal or orbitonasoethmoidal osteotomy, and potentially a sphenoethmoidotomy to provide broad access to malignancies of the anterior, middle, and posterior skull base. The approach enables the en bloc resection of tumors within the frontal lobes, orbits, paranasal sinuses, and sphenoclival corridors without brain retraction and may obviate the need for transfacial access. This can be combined with additional approaches, based on the tumor's epicenter. Reconstruction is accomplished with the use of pericranium, and in some instances, a temporalis muscle pedicle or a gracilis microvascular free flap. Complications include cerebral spinal fluid leakage, pneumocephalus, infection, and cranial neuropathies. However, the morbidity and mortality associated with this approach is low. The extended transbasal approach is a relatively novel exposure that enables the skilled cranial base surgeon to safely excise many malignant lesions previously felt to be unresectable.