Endoscopic management of anterior skull base tumors

Skull base surgery, in general, and anterior skull base surgery, in particular, are relatively young disciplines within otolaryngology-head and neck surgery. Within this new frontier in head and neck oncology, anterior craniofacial resection (ACFR) has become a standard procedure for management of lesions of the anterior cranial base. A review of the progress in head and neck oncologic surgery during the last 40 years shows that ACFR is probably one of the few surgical extirpative procedures that expanded the ability to remove tumors and increase cure rates. Most of the other novel surgical procedures in head and neck surgery were introduced to increase anatomic and functional preservation and to improve reconstruction, but rarely do they increase extirpative abilities. The history of anterior skull base surgery and ACFR has been reviewed by Donald [1]. In 1941, Dandy [2] described resection of an orbital tumor by means of anterior craniotomy, which included entering the ethmoid complex. This report was followed by Rae and McClean [3], who used a combined transorbital-transcranial approach, and by Smith et al [4] who performed a combined transfacial-transcranial approach for tumor removal. ACFR as introduced by Ketcham et al [5] has become the standard procedure for management of lesions of the anterior skull base. In fact, the classic ACFR performed today includes the same facial skin incisions combined with a bicoronal incision and the same bony cuts described by