A review of 59 consecutive patients with lesions of the anterior cranial base operated on using the subcranial approach.

INTRODUCTION: Lesions of the anterior cranial fossa are still a challenge for the surgeon. Since Joram Raveh introduced the concept of a subcranial approach in 1978 it has been used in the treatment of lesions extending into the anterior cranial fossa. Our experience with the subcranial approach during the past 8 years at Turku University Central Hospital is described.

PATIENTS: Fifty-nine consecutive patients underwent surgery using the subcranial approach for treating various benign and malignant neoplasms, for repair of frontobasal-midfacial fractures, and for repair of cerebrospinal fluid leaks.

METHODS: Patient records were retrospectively reviewed, with special focus on surgical technique, early outcome, and complications.

RESULTS: Nineteen of the patients were operated on because of combined fronto-naso-orbital and skull base fractures, 37 were tumour cases, and 3 patients required surgical repair for cerebrospinal fluid leakage. Significant complications consisted of two cases of meningitis. However, they were successfully treated with antibiotics. The most common late complaint was olfactory nerve dysfunction (44), other late complications such as diplopia (4), enophthalmos (2), scar tissue in the nasal cavity (2), and trigeminal nerve dysfunction (2) were also encountered.

CONCLUSION: The subcranial approach affords exposure to the orbital, sphenoethmoidal, and clivus regions, as well as to the nasal and paranasal cavities. On the basis of this review, it is concluded that it is a safe and effective approach for treating lesions involving the anterior skull base.