Surgical management of anterior skull-base malignancies (endoscopic vs. craniofacial resection)

Anterior skull base (ASB) malignancies are rare entities characterized by delayed diagnosis and comprise a variety of distinct histological types. Their treatment involves clinical and surgical management, with the latter encompassing open and, more recently, endoscopic approaches. The craniofacial resection, as an open approach, has revolutionized the treatment of such diseases and is the gold standard, although significant morbidity and facial scars are a shortcoming. Seeking a less invasive alternative, many surgeons have approached these pathologies using the endoscopic endonasal approach, with the theoretical advantage of reduced morbidity and no facial scars. In this manuscript, we aim to review the current state-of-art in the surgical management of the ASB malignancies. As such, indications, limitations and future perspectives of different surgical techniques are discussed.