Approaches to Skull Base
I Anterior Cranial Base
  Anterior craniofacial resection
Basal subfrontal approach
II Middle Cranial Base

Central Compartment  

  Trans septal sphenoid
Transpalatal
Extended maxillotomy
Midfacial split		  

Lateral Compartment  

  Infratemporal fossa approach l case 1 l case 2
Transparotid
Subtemporal preauricular infratemporal fossa approach
Trans facial approaches

  Facial translocation approach l case 1 l case 2
Extended osteoplastic maxillotomy approach
Extended transfacial subcranial approach l case 1 l case 2
III Posterior cranial base

Transtemporal approaches
  Translabyrinthine approach
Transotic approach
Transcochlear approach l Case 1 l Case 2

Extreme lateral/transcondylar approach

 
Skull Base Surgery

Craniofacial Resection

Most of the tumours involving the anterior cranial fossa arise from the sinuses and orbits. Conservative surgery in these areas is fraught with local recurrence at the skull base. The tumours in this region have poor survival rate (8% overall at 5 years). The mortality is caused primarily by uncontrolled local disease, with only 10% dying as a result of metastasis. An overall five-year survival of 60% is observed for those undergoing craniofacial resections for malignant diseases involving the anterior skull base.

Case-1

A 34 year old male had recurrent bleeding from the left nostril. A reddish mass was seen in the left nasal cavity. This was reported as an Olfactory neuroblastoma. MRI showed tumour involving the ethmoid and extending into the anterior cranial fossa. Craniofacial resection was done. Radiation was given post operatively. No recurrence was noted at 2 1/2 years.

 
 

Bicoronal and lateral rhinotomy incisions and their extensions.

 

   MRI shows tumour involving the ethmoid sinus and extending into the anterior cranial fossa.
 

Lateral rhinotomy incision for medial maxillectomy and ethmoidectomy.

 

   Bicoronal incision and bifrontal craniotomy done. Tumour seen close to crista galli.
 

Defect in the anterior cranial fossa floor after the craniofacial resection. Reconstructed with vascularised pericranial flap.

 

   Pericranial flap used to reconstruct the postoperative defect in the anterior cranial fossa floor.
 
Postoperative MRI.   Postoperative photograph showing good cosmesis.