[A broad subfrontal access to the tumors in the base of the skull]

A total of 30 patients, aged 16 to 67, with neoplasms in the brain base and in paranasal sinuses were operated on, during 1997-2002, at Burdenko's Research Institute for Neurosurgery of the Russian Academy of Medical Sciences (RAMS). A majority of patients (21) had meningiomas. Other observations included: fibrous dysplasia of the anterior cranial fossa in 3 patients, chondroma in 2 patients, angiofibroma in 2 patients, pituitary adenoma in 1 patient and adamantinoma in 1 patient. The application of diluted subfrontal approach and of its modifications is indicated for extradural tumors located in the anterior cranial fossa and extending into the latticed main sinus of the nasopharynx. No increasing neurological symptomatology was noticed in any patients. Nasal liquor was not noted either. A seizure of an essential reduction of exophthalmos was registered in cases with crania-orbital neoplasm. It restored postoperatively in all patients with malfunctions of nasal breathing. Two patients died. The death reasons are not directly related with the approach technique. The diluted subfrontal approach is effective in extensive tumors of the anterior cranial fossa involving the latticed and main sinuses. Our experience of using the diluted subfrontal approach showed its efficiency not only in extensive extradural neoplasms but also in large meningiomas of the anterior cranial fossa extending into the latticed sinus, main bone platform, tubercle of sella turcica and into both optic canals. The discussed approach ensures essentially reduced brain traction as compared with the traditional subfrontal approach. The hermetic closure of defects formed in the brain basis is an important surgery stage involving the diluted subfrontal approach. This approach is, under modern conditions, a valuable addition to the methods, which are generally accepted in neurosurgery, and it has undoubtedly an indisputable perspective.