Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective

Pedro Plou; Simona Serioli; Luciano C P C Leonel; A Yohan Alexander; Edoardo Agosti; Larissa Vilany; Stephen Graepel; Garret Choby; Carlos D Pinheiro-Neto; Maria Peris-Celda

doi:10.3390/cancers15092587

Surgical Anatomy and Approaches of the Anterior Cranial Fossa from a Transcranial and Endonasal Perspective

Cancers (Basel). 2023 May 1;15(9):2587. doi: 10.3390/cancers15092587.

Authors

Pedro Plou^{1

2

3}, Simona Serioli^{1

2

4}, Luciano C P C Leonel^{1

2}, A Yohan Alexander^{1

2}, Edoardo Agosti^{1

2

4}, Larissa Vilany^{1

2}, Stephen Graepel¹, Garret Choby^{1

2

5}, Carlos D Pinheiro-Neto^{1

2

5}, Maria Peris-Celda^{1

2

5}

Affiliations

¹ Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
² Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochesrer, MN 55905, USA.
³ Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina.
⁴ Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy.
⁵ Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA.

Abstract

The anterior cranial fossa (ACF) is a complex anatomical region that can be affected by a broad spectrum of pathology. For the surgical treatment of these lesions, many approaches have been described, each of them with different scope and potential surgical complications, often associated with significant morbidity. Traditionally, tumors involving the ACF have been operated by transcranial approaches; however, in the last two decades, endoscopic endonasal approaches (EEAs) have been gaining popularity. In this work, the authors review and describe the anatomical aspects of the ACF and the technical nuances of transcranial and endoscopic approaches for tumors located in this region. Four approaches were performed in embalmed cadaveric specimens and the key steps were documented. Four illustrative cases of ACF tumors were selected to demonstrate the clinical application of anatomical and technical knowledge, which are essential in the preoperative decision-making process.

Keywords: anterior cranial fossa; endoscopic endonasal approach; skull base surgery; surgical anatomy; transcranial approach.

Publication types

Review

Grants and funding

This research was funded by the Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; the Joseph and Barbara Ashkins Endowed Professorship in Surgery and the Radiology Department; Charles B. and Ann L. Johnson Endowed Professorship in Neurosurgery Department, Mayo Clinic, Rochester Minnesota.