Combined Subfrontal and Endonasal Approach

Indications

• The major advantages of this approach include broad exposure to the anterior cranial base with minimal brain retraction.

• The approach can facilitate the access to the anterior skull base, especially at the midline, including orbits, planum sphenoidale, sphenoid sinus, sphenoethmoidal and clival regions, as well as to the nasal and paranasal cavities with direct visualization of the adjacent vital structures.

• This combined approach is very useful for lesions at the sphenoid sinus and parasellar region that extend to the anterior cranial fossa. The endoscopic endonasal approach provides additional access, visualization and maneuverability to the ethmoidal cells, sphenoid sinus and frontal sinus.

• Management of anterior skull base fractures, defects and congenital anomalies.

• CSF leak repair.

• Treatment of extra-axial lesions, including chordomas, meningiomas, infectious and inflammatory disorders.

Contraindications

• Lesions that can be removed through only one approach, either endonasal or subfrontal.

• Patients that could not tolerate surgery due to medical conditions like advanced age with comorbidities or patients with several previous radiation treatments or advanced diabetes in which the healing process may be impaired.

• A lateral approach is better for retrochiasmatic and subchiasmatic lesions.

Surgical Procedure