Complications in Anterior Cranial Fossa Surgery

A variety of neurosurgical disorders affect the anterior cranial base and require an anterior cranial fossa approach. As neurosurgeons, we usually deal with the treatment of benign neoplasms, in particular meningiomas. Nonetheless, other common neurosurgical pathologies include traumatic injuries, craniofacial malformations (i.e., hypertelorism, craniosynostosis), cerebrospinal fluid (CSF) fistulas, and vascular lesions (i.e., arterio-venous fistulas). Although surgery of benign lesions of the anterior cranial fossa is a relatively common procedure, tumors like meningiomas can reach huge sizes and encase vital neurovascular structures, making surgery in the area a real challenge. Furthermore, the anterior cranial base is also involved by malignant tumors. With some notable exceptions (leukemia, lymphoma, myeloma, metastases), malignant neoplasms are treated surgically but require adjuvant radiation or chemotherapy. Malignant lesions are generally challenging lesions that require a multidisciplinary approach to achieve an en bloc resection with margins of uninvolved tissue after broad circumferential exposure whenever possible.1 Indications for surgical treatment of malignant tumors are influenced by the extent of the lesion taken together with clinical data, including age and performance. Surgical morbidity must be weighed against the anticipated natural course of the lesion and results of nonsurgical treatments, when applicable. Here we briefly describe the transcranial approaches to the anterior cranial fossa and discuss complications commonly encountered in anterior cranial fossa surgery and their avoidance.