The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical-otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival-sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

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Owing to the recent continuous advances in interventional radiologic techniques, it is possible to treat both acute and subacute life-threatening head and neck hemorrhage most efficiently. In many cases the endovascular therapy complements surgery.

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To increase the intraoperative safety factor and to acquire anatomic assistance during revision endoscopic sinus surgery (RESS), we used an optical computer-aided surgery (CAS) system that we developed collaboratively in Bern, Switzerland. During 1 year, 25 RESSs were performed with CAS: recurrent polyposis (n = 20), recurrent frontal recess stenosis (n = 3), and recurrent frontal recess stenosis with mucocele (n = 2). These patients were compared with a control group of 10 patients undergoing RESS without CAS. The same surgeon (M.C.) performed all operations, and there were no minor or major complications in either group. The clinical inaccuracy of our system is between 0.5 and 2 mm with paired-point and surface matching. The navigation system is an important aid to surgeons in identifying anatomic landmarks that are typically difficult to visualize in this type of surgery, thus reducing the stress placed on the surgeon.