Application of the supraorbital endoscopic approach to tumors of the anterior cranial base.

Access to tumors of the anterior cranial fossa traditionally has required wide exposure of the surgical field, along with prolonged retraction of the frontal lobes or potentially disfiguring transfacial approaches. These approaches subject patients to undesirable neurologic and cosmetic morbidity. With the introduction of progressively less-invasive approaches, intracranial tumors with craniofacial involvement have become amenable to en bloc resection with a minimum of deleterious consequences. The authors report their experience with a supraorbital endoscopic approach. This technique is suitable for lesions situated in the region of the anterior cranial fossa, the suprasellar, and parasellar regions. The technique was applied to 24 patients. Pathologies treated were meningiomas, craniopharyngiomas, pituitary adenomas with extrasellarextensions, and other variable supratentorial pathologies. The use of endoscopy allowed thorough visualization of all critical structures at the paramedian skull base without the need for a bicoronal scalp flap, bifrontal osteotomies, or brain retraction. Most lesions were resected in their entirety with no perioperative complications and with excellent cosmetic results. These cases demonstrate how the application of endoscopy to surgery of the anterior skull base and craniofacial skeleton can eliminate the need for traditional open techniques without compromising surgical success.