Neurosurgical Review

, 33:63 | Cite as

A modified frontal–nasal–orbital approach to midline lesions of the anterior cranial fossa and skull base: technical note with case illustrations

  • Shaan M. Raza
  • James E. Conway
  • Khan W. Li
  • Frank Attenello
  • Kofi Boahene
  • Prem Subramanian
  • Alfredo Quinones-HinojosaEmail author
Original Article


The frontal–nasal–orbital craniotomy has been utilized for craniofacial abnormalities and resection of tumors involving the anterior skull base. We describe modifications of this technique to approach extra-axial and intradural midline lesions of the anterior fossa with or without involvement of the skull base. A craniotomy was planned with an endoscope and image guidance. A modified frontal–nasal–orbital craniotomy encompassing the entire frontal sinus complex was performed in conjunction with osteotomies incorporating the bilateral superior orbital ridges and nasal septum. Removal of the posterior wall of the frontal sinus was completed if necessary. Dural repair and final reconstruction are detailed. Our initial experience using this approach in five patients harboring lesions of the anterior skull base resulted in adequate exposure of the targeted pathology. There were no complications of the procedure. Cosmetic results were acceptable. We present a detailed account of this procedure via photographs and a video. The frontal–nasal–orbital craniotomy provides access to the floor of the anterior fossa while avoiding excessive brain retraction associated with facial incisions. In addition, this approach is associated with a lower incidence of complications, such as CSF leak, brain retraction edema, or infection. The frontal–nasal–orbital craniotomy is a useful technique for midline lesions of the anterior skull base, and it should be in the armamentarium of neurological surgeons.


Frontal–nasal–orbital craniotomy Anterior cranial fossa 


Supplementary material

Video 1

Frontal–nasal–orbital craniotomy. A compilation of video clips from different operative cases demonstrating the various steps of the approach (MOV 136 mb)


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Shaan M. Raza
    • 1
    • 4
  • James E. Conway
    • 1
    • 4
  • Khan W. Li
    • 1
    • 4
  • Frank Attenello
    • 1
    • 4
  • Kofi Boahene
    • 3
  • Prem Subramanian
    • 2
  • Alfredo Quinones-Hinojosa
    • 1
    • 4
    • 5
    Email author
  1. 1.Departments of NeurosurgeryJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.OphthalmologyJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Otolaryngology-Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreUSA
  4. 4.The Johns Hopkins Neuro-Oncology Surgical Outcomes Research LaboratoryBaltimoreUSA
  5. 5.Brain Tumor Stem Cell Laboratory, Department of Neurosurgery and OncologyBaltimoreUSA

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