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Fernando E. Silva, MD

Fernando E. Silva, MD

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A variety of novel surgical approaches have been developed in recent
years to manage disease of the cranial base. Few offer the width
and depth of exposure achievable with the extended transbasal approach.
This approach combines a bifrontal craniotomy with an
orbitonasal or orbitonasoethmoidal osteotomy, and potentially a
sphenoethmoidotomy to provide broad access to malignancies of the
anterior, middle, and posterior skull base. The approach enables the en
bloc resection of tumors within the frontal lobes, orbits, paranasal sinuses,
and sphenoclival corridors without brain retraction and may
obviate the need for transfacial access. This can be combined with additional
approaches, based on the tumor's epicenter. Reconstruction is
accomplished with the use of pericranium, and in some instances, a
temporalis muscle pedicle or a gracilis microvascular free flap. Complications
include cerebral spinal fluid leakage, pneumocephalus, infection,
and cranial neuropathies. However, the morbidity and mortality
associated with this approach is low. The extended transbasal approach
is a relatively novel exposure that enables the skilled cranial
base surgeon to safely excise many malignant lesions previously felt to
be unresectable.

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