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Craniomaxillofac Trauma Reconstr 2015 Sep 20;8(3):218-20. Epub 2014 Nov 20.

Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.

Subcranial approach is a useful procedure in the management of limited anterior skull base tumors. But the posterior and superior visualization may be limited, in ethmoid malignancies with a large intracranial extension. A 55-year-old male patient, a case of an ethmoid malignancy, with a large intracranial component was resected with adequate margins by a subcranial approach. Read More

Laryngoscope 2011 Mar 4;121(3):468-73. Epub 2011 Feb 4.

Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospital System, Alfred Taubman Health Care Center, Ann Arbor, Michigan, USA.

Objective: To measure the effect of routine perioperative lumbar drain placement during anterior skull base surgery on the frequency of: 1) tension pneumocephalus and 2) total intracranial complications.

Design: Retrospective review of a series of patients (n = 161) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009. A retrospective cohort (n = 45) underwent routine lumbar drain placement at the time of skull base surgery. Read More

Neurocirugia (Astur) 2010 Dec;21(6):467-77

Servicios de Cirugía Oral y Maxilofacial y de Neurocirugía Hospital Universitario 12 de Octubre. Madrid, Spain.

Unlabelled: INTRODUCTION. Suitable approach to anterior cranial base is mandatory to get global satisfactory surgical outcomes. In the beginning it depends on the exactly anatomical position into the cranial fossa and tridimensional spread. Read More

Childs Nerv Syst 2009 Aug 5;25(8):915-23. Epub 2009 May 5.

Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center and Dana Children's Hospital, Tel-Aviv University, Tel-Aviv, Israel.

Introduction: Post-traumatic cerebrospinal fluid leak from the anterior cranial fossa in children may be isolated or combined with severe facial and calvarial injury. Untreated leak may result with meningitis, hydrocephalus, and abnormal neurocognitive development.

Patients And Methods: We present nine children, ages 4-16 years, with complicated craniofacial injury treated by a combined subcranial and intracranial approach. Read More

Skull Base 2008 Jan;18(1):29-47

Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

The transbasal approach offers extradural exposure of the anterior midline skull base transcranially. It can be used to treat a variety of conditions, including trauma, craniofacial deformity, and tumors. This approach has been modified to enhance basal access. Read More

Facial Plast Surg 2008 Jan;24(1):129-34

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.

The most innovative and meaningful recent advances regarding surgery of the cranial base involve the ability to perform a complete resection followed by a water- and airtight reconstruction while minimizing facial incisions and morbidity. Perhaps the first step in this direction took place when the subcranial/subfrontal approach was introduced for anterior skull base surgery. Originally developed by Raveh in 1978 for the management of severe skull base injuries, these approaches were later adapted for the treatment of congenital anomalies prior to their utilization for resection of anterior skull base tumors. Read More

Skull Base Surg 1999 ;9(2):95-100

The authors have successfully utilized a modified subcranial approach to the anterior skull base, based upon the procedure first described by Joram Raveh, as an alternative to standard craniofacial resection. The complication rate of this procedure in 31 consecutive cases (28 tumors, 2 congenital malformations, and 1 mucocele) has been 19.4% with no permanent complications, no deaths, no new neurological deficits, no brain injuries, no infections, and no seizures. Read More

J Craniomaxillofac Surg 2006 Oct 11;34(7):405-11. Epub 2006 Sep 11.

Department of Otorhinolaryngology, Head and Neck Surgery, Turku University Central Hospital, Turku, Finland.

Introduction: Lesions of the anterior cranial fossa are still a challenge for the surgeon. Since Joram Raveh introduced the concept of a subcranial approach in 1978 it has been used in the treatment of lesions extending into the anterior cranial fossa. Our experience with the subcranial approach during the past 8 years at Turku University Central Hospital is described. Read More

Neurosurg Focus 2002 May 15;12(5):e10. Epub 2002 May 15.

Department of Otolaryngology-Head and Neck Surgery, Institute of Pathology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Object: The goal of this study was to demonstrate the efficacy of a simple and reliable technique for anterior skull base and craniofacial reconstruction in patients who have undergone excision of tumors via the subcranial approach.

Methods: There were 63 patients who had undergone 71 anterior skull base resections of tumors via the aforementioned approach. Twenty-nine cases (41%) involved malignant tumors and 42 (59%) involved benign tumors. Read More

Plast Reconstr Surg 2005 Aug;116(2):395-8; discussion 399

Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Background: Classic craniofacial resection and the subcranial approach are well-established techniques for the removal of tumors involving the anterior skull base. These techniques require frontal craniotomy to allow broad exposure of the anterior cranial fossa, a procedure that may be further complicated by local infection and osteomyelitis or because of a reduction in tissue perfusion and direct communication between the osteotomy and the contaminated nasoethmoidal cavity. The authors present a new method for wrapping of the frontal bone segment with a pericranial flap with the intention of preventing these serious complications. Read More

Acta Neurochir (Wien) 2005 Apr 3;147(4):355-66; discussion 366. Epub 2005 Mar 3.

Department of Cranimaxillofacial, Skull Base, Facial Plastic and Reconstructive Surgery, University Hospital, Inselspital, Berne, Switzerland.

Fractures of the anterior skull base, because of the region's anatomical relationships, are readily complicated by neurological damage to the brain or cranial nerves. This review highlights the use of a subcranial approach in the operative treatment of injuries of the anterior skull base and compares it to the more traditional neurosurgical transcranial approach. The extended anterior subcranial approach takes advantage of the specific features of injuries in this region and allows direct access to the central anterior cranial base in order to repair fractures, close CSF fistulae and relieve of optic nerve compression. Read More

Otolaryngol Head Neck Surg 2003 May;128(5):681-5

Skull-Base Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel.

Objective: Although anterior skull base surgery has become a relatively safe and effective procedure, postoperative complications remain a serious problem. One of the most devastating complications of anterior skull base procedures is tension pneumocephalus (TP). In order to prevent TP, authors have recommended the use of prophylactic airway diversion procedures, such as prolonged endotracheal intubation or prophylactic tracheostomy. Read More

Otolaryngol Head Neck Surg 2003 Jan;128(1):43-7

Skull-Base Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.

Objective: We sought to evaluate surgical wound infection rates in patients undergoing skull base surgery without hair removal.

Methods: We undertook a retrospective study of 175 skull base operations performed without hair removal. Anterior operations were conducted via the subcranial approach (n = 120) and lateral or posterior procedures via various approaches (n = 55). Read More

Neurochirurgie 2002 May;48(2-3 Pt 1):87-91

Département de Neurochirurgie, Hôpital Hôtel-Dieu de France.

Background And Purpose: Over the time, the management of cerebrospinal fluid (CSF) rhinorrhea has been a major surgical challenge. In this paper, we will describe our experience using the extended anterior subcranial approach for the repair of extensive or previously treated CSF leaks. This approach consists of a nasoorbitofrontal bony flap, then an ethmoidectomy and sphenoidectomy are performed and the empty space is filled with subcutaneous fat, a pediculated periostal flap is dissected and layed extradurally at the base of the anterior cranial fossa. Read More

J Oral Maxillofac Surg 2001 Oct;59(10):1171-5

Skull Base Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine Tel-Aviv University, Tel Aviv, Israel.

Purpose: Because of the likelihood of meningitis and other intracranial complications, optimal treatment for a cerebrospinal fluid (CSF) fistula is to close the leak. The neurosurgical approach to the management of CSF rhinorrhea has been by intracranial access. Extracranial approaches are now gaining acceptance as the preferred method for initial treatment of CSF leakage, because the success rates are reasonable, and the morbidity is lower. Read More

Ann Otolaryngol Chir Cervicofac 2000 Dec;117(6):367-373

Service d'ORL et de chirurgie cervico-faciale, Hôpital Soroka, B.P. 151, Beer-Sheva, 84101. Israël.

We reviewed the cases of 75 patients who underwent an extended subcranial approach to the anterior skull base for treatment of various tumors (35 patients), repair of craniofacial trauma injury (33 patients), or cerebrospinal fluid leakage (10 patients). Preoperative evaluation and surgical procedures were reassessed. Significant complications in the oncology group consisted of one hematoma requiring aspiration, 2 cases of transient pneumocephalus, 2 osteocutaneous fistulae and 2 epiphoras. Read More

Laryngoscope 1999 Jan;109(1):153-60

Head and Neck Surgical Oncology Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Objectives: To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure.

Study Design: Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. Read More

J Neurosurg 1995 Jun;82(6):1002-10

Department of Craniomaxillofacial, Facial Plastic and Reconstructive Surgery, University of Bern, Switzerland.

The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical-otolaryngological resection of various skull base tumors. Read More

J Craniomaxillofac Trauma 1995 ;1(4):56-62

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.

The subcranial approach to the cranio-orbito-frontal junction allows direct access to the central anterior cranial base for repair of fractures, dural tears, and cerebrospinal fluid fistulae. It provides good visualization without brain retraction and is suitable in primary or delayed traumatic cases. For extended visualization, a portion of the frontal sinus may be removed and repositioned at the end of the procedure. Read More

Arch Otolaryngol Head Neck Surg 1993 Apr;119(4):385-93

Department of Cranio Maxillofacial Facial Plastic and Reconstructive Surgery, Otolaryngology Head and Neck Surgery, University of Bern, Switzerland.

We describe 78 patients with fronto-orbital and sphenoethmoidal tumors surgically treated with the subcranial approach. This approach was developed by us in 1978 primarily for the treatment of skull-base trauma and craniofacial anomalies. Since 1980, we have extended the indications to include tumor resections. Read More

Arch Otolaryngol Head Neck Surg 1988 Oct;114(10):1114-22

Department of Maxillofacial Surgery, University of Berne, Switzerland.

In severe craniofacial injuries, the involvement of the skull base with concomitant major dural tears is significantly high. Our methods and treatment plan are controversial compared with the conventional procedure: primary urgent neurosurgical exploration and repair with deferral of maxillofacial reconstruction. To avoid the disadvantages of the transfrontal intracranial management of the skull base, we modified the transethmoidal approach so as to enable the subcranial exposure of all the anterior fossa planes, including the sellar-sphenoidal region. Read More

J Craniomaxillofac Surg 1988 May;16(4):160-72

Department of Maxillofacial Surgery, University of Bern, Switzerland.

The aim of this paper is to emphasize the advantages of a one-stage, step by step repair of facial skeletal injuries as well as the dural tears and lesions of the anterior fossa, by one and the same team. The methods described permit optimal reduction of the pseudohypertelorism and major displacements in severe combined craniofacial injuries. The simultaneous subcranial exposure of the entire basal region of the anterior fossa obviates the intracranial approach or frontal lobe retraction thus making early stage surgical management feasible. Read More