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Tumors involving the base of the skull are best approached by the transbasal route as described by Derome. However this approach can be improved by mobilization of the medial part of the supra-orbital ridge according to the technical principles used in treatment of craniosynostosis. This allows a wide exposure of the ethmoido-sphenoidal area with minimal retraction of the frontal lobes. The axis of working becomes parallel and even inferior to the plane of the cribriform plate and gives a better access to the upper part of the clivus. Rhinologic complementary approach (rhinoseptal or transfacial) can be associated with this technique. However a more anterior part of the nasal mucosae is exposed by this procedure: one can control the mucosae in front of the tumor and avoid a complementary rhinoseptal route. This simple technical trick has been used in seven cases with satisfactory results.

33 cases of fronto-cranial remodeling by osteotomies are reported by the authors. Since 1973, 19 oxycephalies have been operated according to an original technique based on two principles:--rocking and advancement of the supra-orbital barr, with an easy lateral retention by a Z-bony cut.--transposition of free bone flaps to rebuild a forehead of the appropriate curvature. The good results obtained have encouraged the authors to operate on young children or even babies in order to solve simultaneously the functionnal and the aesthetic problems. Three plagiocephalies, two trigonocephalies have thus been treated, as well as 5 facio-craniostenosis for whom a 2 cm forehead advancement has been done, the following results being very encouraging.