Objective: This article aims to describe the outcome of patients with selected tumors encroaching
the anterior skull base, utilizing combinations of the subcranial approach.
Patients and Methods: Retrospective study of 113 patients presenting with benign and malignant tumors encroaching
the anterior skull base, treated in a single cancer center with combined subcranial
approaches, in the period from 2000 to 2024. We aim to compare the results of this
technique with the results of patients treated by the classic craniofacial technique,
as well as, with data from the international literature. The surgical results, survival,
and complications were measured.
Results: Of the 113 patients included in the study, most had a subcranial approach without
facial incisions (72 patients—63%). The average duration of surgery was 7.45 hours.
Patients spent an average of 2 days in the intensive care unit and 7 days hospitalized.
The incidence of complications was 32%, with sinocutaneous fistula near the orbital
region being the primary complication, occurring in 27% of cases. Additionally, 14%
of patients developed liquoric fistula, managed conservatively without requiring surgical
reintervention. There were no reported cases (0%) of meningoencephalitis or neurological
complications. Adjusted 5-year overall survival was 58.2%. Complete tumor resection
was achieved in all cases (100%).
Conclusion: This surgical approach offered reduced neurological and general complications, a
tendency toward shorter surgical times, lower rates of blood transfusion, decreased
intensive care unit and hospital stays, and feasibility for the resection of selected
craniofacial tumors involving the anterior skull base. Depending on tumor size, the
technique can be applied with or without facial access, with a preference for the
latter in the majority of cases we manage.
