The transnasal versus transcranial approach to lesions of the anterior skull base

摘要

The standard microsurgical frontotemporal craniotomy, known as the pterional approach, involves the microsurgical splitting of the Sylvian fissure, provides excellent access for many such lesions, and is the mainstay of cranial microneurosurgery (Table 2). As skull base concepts have evolved, however, many lesions are treated more effectively by other microneurosurgical craniotomy techniques. These include the orbito-frontal craniotomy, which also involves splitting of the Sylvian fissure and resection of the anterior clinoid process. An extension of this concept is the orbito-fronto-zygomatic craniotomy (i). Bifrontal craniotomies and transcallosal approaches are described, and are occasionally utilized for suprasellar lesions. With the advent of the operating endoscope, the eyebrow-based minimally invasive craniotomy has become another effective option for certain anterior skull base tumors of the suprasellar region.