Microsurgical Anatomy Review of Bifrontal Limited Transbasal Approach – Quantitative and Anatomy Study

Introduction The bifrontal transbasal approach is an anterior midline skull base approach to anterior skull base, sellae region and, if needed, to posterior skull base in the midline, often used for tumoral lesions but also useful for vascular or infectious pathologies. Methods Descriptive anatomic study, 5 formalin-fixed human cadaveric heads were used injected with colored silicone. The dissection was made step-by-step to describe every anatomic structure encountered. The working distance was obtained from the posterior wall of the frontal sinus with and without orbital rim to the pituitary stalk, the sellae, the pontomedullary sulcus, and the anterior margin of the foramen magnum. Results Stepwise anatomic dissection was performed dividing the surgical technique into 6 stages: soft-tissue stage, bone stage, sinus stage, clival stage, intradural, and measurements. The objective of making the supraorbital osteotomy was to improve the vision over the neural structures without brain retraction and limited to the midline supraorbital rim to avoid aggressive manipulation and injury to the orbit. The working distances measured with the orbital rim were on average: to the pituitary stalk, 70.5 mm; to the sellae, 81.3 mm; to the pontomedullary sulcus, 97 mm; and the foramen magnum, 99.5 mm. Without the orbital rim measures were: to the pituitary stalk, 57 mm; to the sellae, 62.5 mm; to the pontomedullary sulcus, 96 mm; and the foramen magnum, 98.5 mm. Conclusions The addition of osteotomies including removing of the orbital rim improves the access to the central skull base with special benefits on the working distances to the sellae region.