Minimally Invasive Transfrontal Sinus Approach to Resection of Large Tumors of the Subfrontal Skull Base

Objectives/Hypothesis: To review our favorable experience with a minimally invasive transfrontal sinus approach to tumors of the subfrontal region. Study Design: Retrospective review in a tertiary care referral practice. Methods: Patients undergoing anterior skull base surgery by the senior author (Y.D.) were reviewed and transfrontal sinus approach patients selected for review. All cases of transfrontal sinus approaches to the base of the anterior cranial fossa from 2007 to 2011 were reviewed in a retrospective fashion. Results: A total of 14 cases were noted. Male to female ratio was 10 to 4 with an average age of 58.2 years. The pathologies included: meningioma (n = 6), esthesioneuroblastoma (n = 3), squamous cell carcinoma (n = 3), adenocarcinoma (n = 1), and adenoid cystic carcinoma (n = 1). Five intradural and nine extradural dissections were performed. No major complications were noted, and no patients required conversion to a traditional transfacial approach or required the use of a craniotomy. Twelve patients underwent complete tumor removal, whereas two patients underwent subtotal tumor removal. Reasons for subtotal removal were not access related but rather tumor characteristic related (carotid artery wall involvement, optic chiasm involvement). Contraindication to this approach is the presence of a hypoplastic or aplastic frontal sinus. Conclusions: The minimally invasive transfrontal sinus approach to the subfrontal region provides ready expeditious access to the base of the anterior cranial fossa without the need for brain retraction, craniotomy or naso-orbital osteotomies. It represents an excellent alternative in the surgical access of both intra-and extradural tumors in this region of the skull base.