Anterior midline approaches to the central skull base

Anterior midline approaches are safe and appropriate for extradural lesions of the central brain base. They are occasionally warranted for intradural lesions as well. Transnasal routes expose the clivus well. They are readily expanded superiorly, inferiorly, and laterally. Recent innovations are reductive; they expand exposure with less facial disassembly. Lateral and most intradural extensions of lesions warrant more lateral approaches.