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Skull base surgery. 1999; 9(2): 95–100.
PMCID: PMC1656816

Craniofacial Resection

Decreased Complication Rate with a Modified Subcranial Approach

Abstract

The authors have successfully utilized a modified subcranial approach to the anterior skull base, based upon the procedure first described by Joram Raveh, as an alternative to standard craniofacial resection. The complication rate of this procedure in 31 consecutive cases (28 tumors, 2 congenital malformations, and 1 mucocele) has been 19.4% with no permanent complications, no deaths, no new neurological deficits, no brain injuries, no infections, and no seizures. Minor complications without permanent sequelae included two cases of tension pnenmocephalus, a subdural hygroma, two transient cerebrospinal fluid leaks, and a case of bacterial meningitis secondary to fecal contamination of a lumbar drain in a child. Average length of hospitalization was 7.1 days (range 2 to 16 days). The overall complication rate is considerably below the complication rate for other reported craniofacial procedures. We describe the technique we have used and the results. The subcranial approach as described herein provides wide exposure of the anterior cranial base without brain retraction, does not require prolonged operating times or hospitalization, and has a potentially lower complication rate than reported for other transfrontal transbasal approaches.

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Selected References

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  • Deschler DG, Gutin PH, Mamelak AN, McDermott MW, Kaplan MJ. Complications of anterior skull base surgery. Skull Base Surg. 1996;6(2):113–118. [PMC free article] [PubMed]
  • Goel A. Anterior transcranial (craniofacial) resection of tumors of the paranasal sinuses: surgical technique and results. Neurosurgery. 1997 Jan;40(1):218–220. [PubMed]
  • Spetzler RF, Herman JM, Beals S, Joganic E, Milligan J. Preservation of olfaction in anterior craniofacial approaches. J Neurosurg. 1993 Jul;79(1):48–52. [PubMed]
  • KETCHAM AS, WILKINS RH, VANBUREN JM, SMITH RR. A COMBINED INTRACRANIAL FACIAL APPROACH TO THE PARANASAL SINUSES. Am J Surg. 1963 Nov;106:698–703. [PubMed]
  • SMITH RR, KLOPP CT, WILLIAMS JM. Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer. 1954 Sep;7(5):991–994. [PubMed]
  • Van Buren JM, Ommaya AK, Ketcham AS. Ten years' experience with radical combined craniofacial resection of malignant tumors of the paranasal sinuses. J Neurosurg. 1968 Apr;28(4):341–350. [PubMed]
  • Derome P. Les tumeurs sphéno-ethmoïdales. Possibilités d'exérèse et de réparation chirurgicales. Neurochirurgie. 1972 May;18(1 Suppl):1–164. [PubMed]
  • Arita N, Mori S, Sano M, Hayakawa T, Nakao K, Kanai N, Mogami H. Surgical treatment of tumors in the anterior skull base using the transbasal approach. Neurosurgery. 1989 Mar;24(3):379–384. [PubMed]
  • Blacklock JB, Weber RS, Lee YY, Goepfert H. Transcranial resection of tumors of the paranasal sinuses and nasal cavity. J Neurosurg. 1989 Jul;71(1):10–15. [PubMed]
  • Frazier CH. I. An Approach to the Hypophysis through the Anterior Cranial Fossa. Ann Surg. 1913 Feb;57(2):145–150. [PubMed]
  • Fujitsu K, Saijoh M, Aoki F, Sakata K, Fujii S, Mochimatsu Y, Kuwabara T. Telecanthal approach for meningiomas in the ethmoid and sphenoid sinuses. Neurosurgery. 1991 May;28(5):714–720. [PubMed]
  • Haines SJ, Marentette LJ, Wirtschafter JD. Extended fronto-orbital approaches to the anterior cranial base: variations on a theme. Skull Base Surg. 1992;2(3):134–141. [PMC free article] [PubMed]
  • Jackson IT, Marsh WR, Hide TA. Treatment of tumors involving the anterior cranial fossa. Head Neck Surg. 1984 May-Jun;6(5):901–913. [PubMed]
  • Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach: technical note. Neurosurgery. 1982 Oct;11(4):537–542. [PubMed]
  • Kawakami K, Yamanouchi Y, Kawamura Y, Matsumura H. Operative approach to the frontal skull base: extensive transbasal approach. Neurosurgery. 1991 May;28(5):720–725. [PubMed]
  • Persing JA, Jane JA, Levine PA, Cantrell RW. The versatile frontal sinus approach to the floor of the anterior cranial fossa. Technical note. J Neurosurg. 1990 Mar;72(3):513–516. [PubMed]
  • Sekhar LN, Nanda A, Sen CN, Snyderman CN, Janecka IP. The extended frontal approach to tumors of the anterior, middle, and posterior skull base. J Neurosurg. 1992 Feb;76(2):198–206. [PubMed]
  • Shah JP, Sundaresan N, Galicich J, Strong EW. Craniofacial resections for tumors involving the base of the skull. Am J Surg. 1987 Oct;154(4):352–358. [PubMed]
  • Sundaresan N, Shah JP. Craniofacial resection for anterior skull base tumors. Head Neck Surg. 1988 Mar-Apr;10(4):219–224. [PubMed]
  • Raveh J, Vuillemin T. The surgical one-stage management of combined cranio-maxillo-facial and frontobasal fractures. Advantages of the subcranial approach in 374 cases. J Craniomaxillofac Surg. 1988 May;16(4):160–172. [PubMed]
  • Raveh J, Vuillemin T, Sutter F. Subcranial management of 395 combined frontobasal-midface fractures. Arch Otolaryngol Head Neck Surg. 1988 Oct;114(10):1114–1122. [PubMed]
  • Raveh J, Vuillemin T. Advantages of an additional subcranial approach in the correction of craniofacial deformities. J Craniomaxillofac Surg. 1988 Nov;16(8):350–358. [PubMed]
  • Raveh J, Vuillemin T. Subcranial-supraorbital and temporal approach for tumor resection. J Craniofac Surg. 1990 Jan;1(1):53–59. [PubMed]
  • Raveh J, Laedrach K, Speiser M, Chen J, Vuillemin T, Seiler R, Ebeling U, Leibinger K. The subcranial approach for fronto-orbital and anteroposterior skull-base tumors. Arch Otolaryngol Head Neck Surg. 1993 Apr;119(4):385–393. [PubMed]
  • Close LG, Mickey B. Transcranial resection of ethmoid sinus cancer involving the anterior skull base. Skull Base Surg. 1992;2(4):213–219. [PMC free article] [PubMed]
  • Ketcham AS, Hoye RC, Van Buren JM, Johnson RH, Smith RR. Complications of intracranial facial resection for tumors of the paranasal sinuses. Am J Surg. 1966 Oct;112(4):591–596. [PubMed]
  • Levine PA, Scher RL, Jane JA, Persing JA, Newman SA, Miller J, Cantrell RW. The craniofacial resection--eleven-year experience at the University of Virginia: problems and solutions. Otolaryngol Head Neck Surg. 1989 Dec;101(6):665–669. [PubMed]
  • Richtsmeier WJ, Briggs RJ, Koch WM, Eisele DW, Loury MC, Price JC, Mattox DE, Carson BS. Complications and early outcome of anterior craniofacial resection. Arch Otolaryngol Head Neck Surg. 1992 Sep;118(9):913–917. [PubMed]
  • Terz JJ, Young HF, Lawrence W., Jr Combined craniofacial resection for locally advanced carcinoma of the head and neck II. Carcinoma of the paranasal sinuses. Am J Surg. 1980 Nov;140(5):618–624. [PubMed]
  • McCutcheon IE, Blacklock JB, Weber RS, DeMonte F, Moser RP, Byers M, Goepfert H. Anterior transcranial (craniofacial) resection of tumors of the paranasal sinuses: surgical technique and results. Neurosurgery. 1996 Mar;38(3):471–480. [PubMed]

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