Single flap fronto-temporo-orbito-zygomatic craniotomy for skull base lesions

Surgery was performed, through single flap fronto-temporo-orbito-zygomatic approach in 22 patients with skull base lesions. In two of these patients, this approach was combined with a transpetrosal approach. The pathological spectrum consisted of trigeminal neurofibromas (5), spheno-orbital meningiomas (4), carotico-ophthalmic aneurysms (4), basilar top aneurysms (2), cavernous sinus haemangiomas (2), invasive pituitary tumours (2) and one patient each of metastatic adenocarcinoma of the cavernous sinus, transcranial fungal granuloma and tubercular granuloma of the cavernous sinus. Of the 14 tumours, 10 were excised totally/near totally while a subtotal excision was achieved in four. Removal of the anterior clinoid process facilitated the clipping of all the carotico-ophthalmic aneurysms. One basilar top aneurysm was wrapped and the other clipped. One patient of fungal granuloma died of fungal meningitis and one patient of basilar top aneurysm expired as a result of thalamic infarct. The advantages of this approach included excellent exposure of the skull base lesions, making the dissection distance shorter and wider, minimal brain retraction and easy replacement of the single bone flap.