[The latest innovations in the operation of en-bloc resection on the frontal skull base]

We have organized skull base surgery teams with otolaryngologists, neurosurgeons and plastic surgeons since 1993 and managed frontal skull base malignancies by a combined transbasal and transfacial approach. However, in the maneuvers, several problems are yet to be solved in minimizing tumor recurrence and postoperative complications. We have recently developed a microscopic en-bloc resection method assisted by an endoscope, and VFOT flap (vascularized frontal outer table flap) for the reconstruction on the frontal skull base. The VFOT flap can be elevated simultaneously with bifrontal craniotomy. The pedicled calvarian bone is split, and the frontal outer table with the pericranium is placed on the frontal base defect caused by the tumor resections. Those procedures seem to be useful for skull base surgery, and easy to perform for neurosurgeons.