title: The extended frontal approach to tumors of the anterior, middle, and posterior skull base.
abstract: The extended frontal approach is a modification of the transbasal approach of Derome. The addition of a bilateral orbitofrontal or orbitofrontoethmoidal osteotomy improves the exposure of midline lesions of the anterior, middle, and posterior skull base, while minimizing the need for frontal lobe retraction. The authors present a 5-year experience with 49 patients operated on via the extended frontal approach. In seven patients, the extended frontal approach was used alone; in the remaining 42, it was combined with other skull base approaches. Highly malignant tumors were removed en bloc, whereas benign tumors and low-grade malignancies were removed either en bloc or piecemeal. Reconstruction was usually performed using fascia lata, a pericranial flap, and/or autologous fat. A temporalis muscle flap or a distant microvascular free flap was required for some patients. One patient died 1 month postoperatively due to superior mesenteric artery thrombosis. Three patients had postoperative infections, two had cerebrospinal fluid leaks requiring reoperation, and four had brain contusions or hematomas. All but two patients recovered to their preoperative functional level. After an average follow-up period of 26 months (range 6 to 56 months), 64% of patients with benign lesions, 64% of patients with low-grade malignancies, and 44% of patients with high-grade lesions were alive with no evidence of disease.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
authors.forename: L N
authors.initials: LN
authors.lastname: Sekhar
authors.forename: A
authors.initials: A
authors.lastname: Nanda
authors.forename: C N
authors.initials: CN
authors.lastname: Sen
authors.forename: C N
authors.initials: CN
authors.lastname: Snyderman
authors.forename: I P
authors.initials: IP
authors.lastname: Janecka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002817:Chordoma / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012888:Skull Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome