Abstract
We present a combined approach for the removal of large tumors involving the skull base, called the "combined pterional-subcranial approach." Use of the subcranial approach allows for a wide exposure of nearly the entire anterior skull base, from the cribriform roof of the ethmoid labyrinth posteriorly to the sphenoid and clivus, and laterally to the orbital roofs, with relatively little retraction of the brain. Addition of a unilateral pterional approach adds exposure to the most lateral aspect of the ipsilateral orbit, the retro-orbital region, as well as the sellar and chiasmatic regions. Dissection in the region of the cavernous sinus is also made easier by this combined technique. We review the background of these 2 surgical approaches and describe the technique of the combined approach.
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