Lesions involve the skull base in most cases by extension from paranasal sinuses, orbits, infratemporal fossa or from an intra cranial location.
During the last decade, skull base surgery, considered by many surgeons as the last frontier for both the craniofacial and neurosurgeon, has reached the status of a speciality. The techniques of skull base surgery incorporates and integrates the principles of different fields as craniofacial surgery, otolaryngology, ophthalmology, neurosurgery, both diagnostic and interventional radiology, anaesthesia.
Since the skull base is covered by the facial skeleton and soft tissue, the logical way for the exposure of this area is Dismantling and Reassembling of the facial skeleton. The foundations of skull base surgery can be traced back to the developments in orthognathic surgical techniques which made translocation of any part of the facial skeleton possible. In addition craniofacial surgery pioneered by Tessier paved the way for a wider application of these principles in developing techniques to access areas of the skull base and brain. These broadly fall into the categories of transfacial approach, transoral/transpharyngeal approaches and lateral approaches. In addition they can be classified as access osteotomies utilizing pedicled and non pedicled bone flaps. Much of the pioneering work was done by Curioni and Janecka who were amongst the first to introduce the use of pedicled and non pedicled flaps in skull base surgery.
Altemir described a transfacial approach employing a lateral rotation of the maxilla and the zygoma to access tumors of the paranasal sinuses and retromaxillary area. A frontonasal osteotomy is described by Panje et al to access anterior skull base. Curioni and Clauser et al, brought the concept of facial dismantling and reassembly on pedicled flaps.