Proposed Classification for the Transbasal Approach and Its Modifications

Feiz-Erfan, Iman; Spetzler, Robert F.; Horn, Eric M.; Porter, Randall W.; Beals, Stephen P.; Lettieri, Salvatore C.; Joganic, Edward F.; DeMonte, Franco

doi:10.1055/s-2007-994292

Cited by 67 publications

(30 citation statements)

References 61 publications

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“…In addition, the approach provides excellent dural closure which may be more difficult with endoscopic techniques discussed below. This approach has been classified based on the extent of bone removal with four different levels [20].…”

Section: Key Pointsmentioning

confidence: 99%

The evolving role of the oculoplastic surgeon in skull base surgery

Allen

2016

Current Opinion in Ophthalmology

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Section: Key Pointsmentioning

confidence: 99%

The evolving role of the oculoplastic surgeon in skull base surgery

Allen

2016

Current Opinion in Ophthalmology

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“…To compare our method with the traditional 2-piece TBA, after all measurements were made, the remaining orbital roof bone that would be accessible transcranially in a 2-piece TBA ("Level I") was removed. 8 Mild frontal lobe retraction was applied, and retractors were not moved between the 1-piece and 2-piece measurements. The ethmoid bone and planum sphenoidale were left intact.…”

Section: Morphometric Analysismentioning

confidence: 99%

“…8 Building on an extensive experience with the 1-piece orbitozygomatic craniotomy, we have recently adopted a 1-piece TBA for anterior cranial fossa and skull base pathologies. This study aimed to describe a 1-piece transbasal approach (consistent with a Level I TBA in the Feiz-Erfan classification scheme), and to objectively compare our 1-piece TBA to the more traditional 2-piece approach through cadaveric investigation.…”

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confidence: 99%

The 1-piece transbasal approach: operative technique and anatomical study

Effendi¹,

Rao²,

Momin³

et al. 2014

JNS

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Object The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach. Methods Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma. Results Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm2 ± 360 mm2 vs 2045 mm2 ± 352 mm2, respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically. Conclusions The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.

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“…Specific attention was paid to reconstruction of the anterior skull base, with a goal to create a watertight seal, prevent bacterial ingress into the epidural and subdural spaces, and prevent brain herniation (6,23). Their surgical techniques are in keeping with previously published reports using vascularized pericranial grafts after sinus exenteration (9,(12)(13)(14).…”

mentioning

confidence: 90%