[Modifications of fronto-orbital osteotomy as an approach to the anterior and middle skull base]

Various extracranial, intracranial and combined extra-intracranial approaches have been described for the surgical therapy of tumours of the anterior and medial cranial base. A combined extra-intracranial approach is indicated in cases in which the cranial base tumour spreads out intracranially and at the same time into the main nasal cavity, the paranasal space and/or the orbits. These tumours of the skull base can be surgically removed by two standardised modifications of the fronto-orbital osteotomy--the fronto-orbito-nasal and the fronto-orbito-zygomatic osteotomy. The advantage of these surgical techniques in comparison with other methods is that they permit a good extracranial and intracranial view with only minimal brain trauma. Generally, additional transfacial incisions are unnecessary. The operative techniques are described and the results of 108 cases of tumours of the skull base shown.