title: The Extended Subfrontal and Fronto-Orbito-Zygomatic Approach in Skull Base Meningioma Surgery: Clinical, Radiologic, and Cosmetic Outcome.
abstract: OBJECTIVE
  To review the outcome and cosmetic results of patients undergoing extended subfrontal and fronto-orbito-zygomatic craniotomy for resection of skull base meningiomas.
  
  
  METHODS
  All surgeries were performed in cooperation with an oral and maxillofacial surgeon between 2006 and 2012. Clinical presentation, surgical techniques and complications, cosmetic, clinical, and radiologic outcomes are presented.
  
  
  RESULTS
  This study included 25 consecutive patients with 26 operations. Total and subtotal tumor removal was obtained in 19 (73.1%) and 7 (26.9%) patients, respectively. Permanent postoperative complications were seen in 5 (19.2%) patients. Eight of 10 patients with preoperative visual impairment showed recovery at 6 months follow-up. Anosmia was improved in 50% and no worsening was seen in any case of hyposmia. All patients showed improved or complete correction of exophthalmos, cognitive deficits, and epilepsy. One patient (3.8%) developed a postoperative ptosis. No mortality was documented. All patients reported a favorable cosmetic satisfactory score over 6 (8.67 ± 1.6). Tumor recurrence rate was 7.7% (n = 2).
  
  
  CONCLUSIONS
  The extended subfrontal and fronto-orbito-zygomatic approach, used for resection of meningiomas located in the orbita and the skull base can provide better visibility of the tumor. In addition, these approaches lead to highly satisfying cosmetic and clinical results.
authors.affiliation: *Department of Neurosurgery †Department of Oral and Maxillofacial Surgery Kantonsspital Aarau, Aarau and University Hospital of Basel, Basel, Switzerland.
authors.forename: Jehuda
authors.initials: J
authors.lastname: Soleman
authors.forename: Christoph
authors.initials: C
authors.lastname: Leiggener
authors.forename: Ai-Jeanine
authors.initials: AJ
authors.lastname: Schlaeppi
authors.forename: Jenny
authors.initials: J
authors.lastname: Kienzler
authors.forename: Ali-Reza
authors.initials: AR
authors.lastname: Fathi
authors.forename: Javier
authors.initials: J
authors.lastname: Fandino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy / Q000379:methods*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods; D009915:Orbit / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D015050:Zygoma / Q000601:surgery