Advances in surgical management of malignancies of the cranial base: the extended transbasal approach.

The extended transbasal approach combines a bifrontal craniotomy with an orbital nasal and potentially a sphenoethmoidal osteotomy to provide excellent access to malignancies of the anterior, middle and posterior skull base. The approach enables the en bloc resection of tumors within the frontal lobes, orbits, paranasal sinuses and sphenoclival corridors without brain retraction and may obviate the need for transfacial access. We present our 7-year experience during which 29 patients underwent surgery with the extended transbasal exposure. In 25 patients the extended transbasal approach was used alone; in the remaining four it was combined with additional approaches. With exception of two patients, all lesions were removed en bloc. Reconstruction was accomplished with the use of pericranium and in some instances a temporalis muscle pedicle or a gracilis microvascular free flap. There were no mortalities associated with this approach. Seven patients experienced infections, four patients experienced cerebral spinal fluid (CSF) leakage, two patients who had received adjuvant radiation experienced scalp necrosis, three patients experienced pneumocephalus, and 29 patients experienced cranial neuropathies, the majority of which were loss of olfaction. The average follow-up for our patients was 34 months with a range of 2--62 months.