gms | German Medical Science

Objective: Many approaches to the anterior skull base have been reported: Frequently used are the frontolateral (pterional), the frontobasal and the orbitozygomatic approaches. Recently, endoscopic transnasal approaches became more popular. The benefits of each approach has to be weighed against its complications and limitations, which can be limited control of contralateral neurovascular structures (frontolateral approach), sinus opening (frontobasal approach), lengthy bone work (orbitozygomatic approach) and difficulties in dural closure (endoscopic transnasal approach). Aim of this study is to investigate, if the anterior interhemispheric approach could be an easy, safe and effective alternative.

Method: We have used the anterior interhemispheric approach in 55 patients with anterior skull base tumors (n=36), dural AV fistula (dAVF) (n=9) and frontobasal trauma (n=10). Patient records were evaluated concerning accessibility of the lesion, realization of surgical aims (complete tumor removal, dAVF obliteration, frontobasal revision), and approach related complications. In all cases, postoperative a CT scan within 4 hours was made.

Results: The lesion was easily accessible in 54 of the 55 patients (98%). In one patient with dural tear and skull base fracture, the access was hampered by the genu of the corpus callosum. The surgical aim was achieved in all patients. There were 2 approach-related complications (3.6%) (wound infection n=1; contusion of the genu of the corpus callosum n=1). A contusion of the frontal lobe, which might be expected especially in tumor cases, was excluded by early postoperative CT scan in all cases.

Conclusions: The anterior interhemispheric approach is an easy to use and safe approach to tumorous, vascular and traumatic lesions of the anterior skull base. Therefore, this approach should be part of the armamentarium of the skull base surgeon.