Anterior skull base surgery has evolved significantly over the past 50 years, moving from early experimental attempts to improve dismal control rates associated with a high incidence of life-threatening complications to a well-accepted multidisciplinary subspecialty with proven improved results. Further reduction in perioperative side effects, decreased length of hospital stay, and improved aesthetic results are ongoing goals of the discipline. Modified surgical approaches are constantly under development and review. The standard by which these modifications will be judged remains a bifrontal craniotomy with or without a supraorbital rim approach and with or without a well-camouflaged transfacial extended external ethmoidectomy incision without a lateral rhinotomy. At times endoscopic-assisted approaches provide the visualization that allows foregoing a facial incision, and endoscopic techniques will continue to evolve and disseminate. Selected highly experienced centers are exploring the increased use of endoscopic resections without craniotomy, demonstrating that this approach is feasible for highly selected tumors. A subfrontal approach with minimal brain retraction is occasionally ideal when frontal bone and nasal bone must be removed because of tumor involvement.
ASJC Scopus subject areas