This review examines the changes in the field of anterior skull-base surgery and the rapid advancement that has taken place in the last 10–15 years. Tumours of the anterior skull base that were once considered inoperable are now routinely resected with reliable results and decreasing morbidity. This review highlights the most up-to-date opinions and advances in the surgical management of anterior skull-base tumours. Anterior skull-base surgery literature has been expanded with new anatomic insights, surgical techniques, and data on patient outcomes and quality of life, primarily focusing on minimally invasive, endoscopic techniques. One study examined a series of patients who had open surgery. There were 31 patients who underwent anterior craniofacial resection for malignant tumours of the skull base with at least 18 months’ follow-up. Most patients received adjuvant proton-beam radiation therapy or chemotherapy. The most common delayed complications were orbital including epiphora and nasocutaneous fistula. The article also recognises that anterior skull-base surgery has become progressively more sophisticated with advances in surgical technique and visual technology and patients undergoing traditional anterior approaches should be followed long term for complications. The paper also describes that early quality of life (QOL) data reveals the minimally invasive approaches demonstrate survival rates comparable to those of traditional surgery, with fewer perioperative complications. Studies have demonstrated an improvement in the sino-nasal outcome test (SNOT)-20 and SNOT -22 scores. Preservation of normal sino-nasal physiology during surgery by reducing the degree of middle turbinate resection, avoiding unnecessary antrostomies, and reducing the use of nasoseptal flaps results in less morbidity and earlier recovery in the postoperative period. This is a useful article and summarises changes which have occurred in anterior skull base surgery.

Anterior skull-base surgery: current opinion.
Fletcher AM, Marentette L.
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Susan A Douglas

Sheffield, UK.

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