The extended subfrontal approach for anterior cranial base meningiomas

Meningiomas of the anterior cranial base often reach a large size (>4 cm) prior to their discovery. Symptoms are often subtle and insidious. Anatomic considerations encompass a large spectrum of neuronal, vascular, soft tissue, and bony features. Involvement of the underlying aerodigestive sinuses is common and leads to unique but characteristic complication profiles. The authors present their experience (45 cases, 33% of which were for meningiomas) utilizing the extended subfrontal approach for large midline meningiomas of the anterior cranial base. Detailed surgical technique is presented: patient positioning, soft-tissue dissection, bone work, intradural work, and closure. An overall 12% complication rate was observed. Pitfalls and pearls are detailed.