Transcutaneous transfacial approaches to the anterior skull base

The six-level anatomic classification scheme of transfacial approaches used by the multidisciplinary skull base surgery team at the Barrow Neurological Institute and discussed extensively in these articles is an excellent way to systematically discuss approaches to the anterior and central skull base. Choosing among these options usually involves selecting the best angle of approach in order to minimized brain retraction, as well as optimizing accessibility to structures requiring resection while limiting aesthetic and functional side effects. Have we advanced to the point that we can usually avoid visible transcutaneous facial incisions while not sacrificing the primary goals of tumor resection and minimization of side effects? In this article we will briefly overview the role of transcutaneous approaches to the anterior skull base.