A panoramic approach to the anterior skull base—The combined subfrontal/subcranial and Le Fort I approach

Surgical exposure for massive tumor of the anterior skull base can be difficult. We have combined two surgical approaches, the subfrontal/subcranial approach and the Le Fort I osteotomy approach, to provide panoramic accesses to the anterior skull base. Via this combination of exposures, we have easily accessed and resected tumors extending from the cribiform plate all the way down to the level of the upper cervical spine. Additionally, we have used the nasal endoscope and microscope to assist in our resection. This approach has several advantages, which include ease of post-resection skull base reconstruction and excellent cosmetic results by avoiding anterior facial incisions. We believe this approach should be in the armamentarium of any surgeon resecting massive anterior skull base tumor.