الفهرس 
Surgical anatomy of the anterior skull baseOnly 14 pages are availabe for public view
 |  | from | 165 |  |  |
| | | from | 165 | | |
Abstract
Introduction: Conventional surgical approaches to the anterior skull base lesions include transcranial and transfacial approaches. The morbidity rate is up to 12%. Complications include cerebrospinal fluid leaks, meningitis, intracranial hemorrhage, pneumocephalus, damage to cranial nerves or brain tissue, and unsightly scars. The most dramatic change in the practice of skull base surgery has been the adoption of endoscopic techniques for the treatment of the anterior cranial base lesions. The minimally invasive endoscopic endonasal surgical approaches offer the advantages of avoiding facial incisions, craniotomy and osteotomies; surgery less painful, recovery quicker, and hospital stays are shorter. Several endoscopic endonasal surgical approaches to the anterior skull base have been advocated. These include: transnasal direct, transethmoidal, transseptal, transmaxillary, and transsphenoidal approaches. Nowadays, the majority of lesions in and around the anterior skull base can be managed by endoscopic endonasal approaches. These lesions include: CSF leaks, encephaloceles, mucoceles, and neoplastic lesions. Surgical repair of CSF leaks may be achieved transcranially through a bifrontal craniotomy, extracranially through an external ethmoidectomy or frontal sinusotomy, or transnasally with endoscopic visualization. The low rate of morbidity and high rate of success (up to 100 %) of the endoscopic approach have made it the procedure of choice for the repair of CSF leaks not associated with other intracranial pathology that would warrant a transcranial approach. Dural and skull base defects can be repaired using underlay or overlay grafting or obliteration of the sphenoid sinus; using different types of grafting materials. Graft materials include fat, cartilage or bone free grafts, turbinate or septal composite grafts, and fascia. Traditionally, transcranial approach has been used for repair of encephaloceles. Nowadays, the endoscopic transnasal approach has become the treatment of choice. This approach offers the advantage of allowing complete excision of the encephalocele without the risks of frontal lobe retraction. Endoscopic excision of encephaloceles has been used successfully in children, as young as 6-months. Aim of work: To review the endoscopic endonasal techniques in the management of different anterior skull base lesions, and to compare the results of endoscopic and traditional surgical approaches. Conclusions: Complications of endoscopic skull base surgery are less, versus conventional surgery. These include: Bleeding, fat herniation, retro-orbital hemorrhage, medial rectus damage, optic nerve lesion, CSF leak, pneumocephalus, periorbital emphysema, and epiphora. Active collaboration of rhinologists and neurosurgeons within the concept of team surgery is crucial to obtain the best outcome for the management of diseases involving the anterior skull base.