The Transglabellar/Subcranial Approach to the Anterior Skull Base

Abstract

The transglabellar/subcranial approach to the anterior skull base may be a reasonable technique for the surgical management of lesions in the region of the anterior skull base. It provides excellent exposure of the nasal cavity, the orbits, and the ethmoid and sphenoid sinuses, while allowing wide access to the anterior fossa with a minimum amount of frontal lobe retraction.

Craniofacial resection for tumors of the nasal cavity and paranasal sinuses: A 25-year experience

“…The literature contains many variations of approach and repair, [23][24][25] and although the essential philosophy remains common to all, the length of procedure and complication rate vary considerably. It is worth noting that the duration of the entire operation (mean, 3.3 hours), the hospital stay (mean, 14 days), and the number of serious complications compare favorably with other published series.…”

Prognostic factors in sinonasal tumors involving the anterior skull base

“…5 We have enlarged this procedure in the case of bilateral ethmoid involvement through a modification of the subcranial approach with removal of the anterior wall of the frontal sinus in continuity with a part of the orbital rims and the nasal bones. The subcranial approach 6,18,19 can be tailored in different ways. The size of the frontal bone and the amount of the orbital rims included in the flap are determined by the amount of exposure that will be needed.…”

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

“…Using the intracranial approach, retraction of the frontal lobes is needed. Even though it is generally accepted that brain damage can be avoided by gentle elevation of the frontal lobe, risks of such complications as brain oedema and contusion related to frontal lobe retraction still exist (Shah et al, 1997;Kellman and Marentette, 2001). Using the classic transfacial approach, like a lateral rhinotomy, with or without a Weber-Ferguson facial flap, the facial incisions leave scars and may have other aesthetic sequelae (Raveh et al, 1995(Raveh et al, , 1998Fliss et al, 1999;Hendryk et al, 2004).…”

“…Furthermore, the procedure allows intradural and extradural tumour removal, repair of fractures with dural tears, optic nerve decompression, and repair of CSF leakage. The subcranial approach is performed with minimal frontal lobe manipulation, and external facial incisions can be avoided (Raveh et al, 1995;Fliss et al, 1999;Kellman and Marentette, 2001;Hendryk et al, 2004).…”