title: Exposure of midline cranial base without a facial incision through a combined craniofacial-transfacial procedure.
abstract: OBJECTIVE
  A single-stage combined craniofacial-transfacial approach that exposes the midline cranial base without visible facial incisions is described.
  
  
  METHODS
  Between 1992 and 1998, eight patients underwent surgery for five different anterior cranial base pathological findings: four angiofibromas, one mesenchymal chondrosarcoma, one esthesioneuroblastoma, one odontogenic myxoma, and one encephalocele. In all cases, the surgical exposure consisted of a bicoronal scalp incision with a bifrontal craniotomy and fronto-orbitonasal osteotomy, and then a sublabial incision for transmaxillary exposure.
  
  
  RESULTS
  Gross total resection was achieved in five cases. The encephalocele was resected with complete reconstruction of the bony defect. Seven patients developed complications, primarily wound infections, cerebrospinal fluid leaks, and anemia. Postoperative Karnofsky Performance Scale scores ranged between 80 and 100 (mean, 92.5). Long-term follow-up information (mean, 56 mo; median, 59.5 mo; range, 5-108 mo) was available for all patients.
  
  
  CONCLUSIONS
  Large anterior cranial base lesions can be resected and excellent cosmetic outcomes can be achieved with a single-stage combined transfacial-craniofacial approach that exposes the entire midline cranial base and requires no facial incisions.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Iman
authors.initials: I
authors.lastname: Feiz-Erfan
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Han
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.forename: Randall W
authors.initials: RW
authors.lastname: Porter
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klopfenstein
authors.forename: Mauro A T
authors.initials: MA
authors.lastname: Ferreira
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Beals
authors.forename: Edward F
authors.initials: EF
authors.lastname: Joganic
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003399:Craniotomy / Q000379:methods; D004677:Encephalocele / Q000000981:diagnostic imaging / Q000601:surgery; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery