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P327: TRANSETHMOIDAL TRANSCRIBRIFORM ENDOSCOPIC APPROACH TO THE ANTERIOR CRANIAL FOSSA: TECHNICAL NUANCES, INDICATIONS, AND OUTCOMES
Edgar G. Ordóñez-Rubiano¹; Laura Baeza-Antón²; Antonia Cadavid-Cobo¹; Alejandra Ramírez-Romero¹; Martín Pinzón³; Fernando Hakim⁴; ¹Department of Neurosurgery, Fundación Universitaria de Ciencias de la Salud - Hospital de San José, Bogotá, Colombia; ²Hospital Comarcal de Melilla, Melilla, Spain; ³Department of Otorhinolaryngology, Fundación Universitaria de Ciencias de la Salud - Hospital de San José, Bogotá, Colombia; ⁴Department of Neurosurgery, Fundación Santa Fe de Bogotá, Colombia

Introduction: Extended endoscopic endonasal approaches have significantly advanced the surgical management of anterior skull base lesions. The transethmoidal transcribriform approach provides a minimally invasive corridor to the anterior cranial fossa and nasal cavity, avoiding large craniofacial osteotomies and brain retraction. This study describes the technical details, indications, and limitations of this approach, and reports a case series of patients treated with this technique.

Methods: A retrospective review was performed of patients with anterior cranial fossa tumors with endonasal extension who underwent resection via the transethmoidal transcribriform approach. The surgical technique is detailed, including patient positioning, anatomical landmarks, endoscopic dissection, tumor resection, and multilayered reconstruction strategies. Postoperative outcomes, complications, and follow-up were analyzed.

Results: Four patients with lesions of the anterior cranial fossa extending into the nasal cavity were treated with the transethmoidal transcribriform approach: two with meningiomas and two with inverted papillomas. Gross total resection was achieved in all cases. A multilayered closure was performed in each case using autologous fascia lata, fat graft, and vascularized nasoseptal flap. One patient developed postoperative cerebrospinal fluid (CSF) leakage, successfully managed with reoperation and reinforcement of the closure. No patients experienced intracranial infection or neurological deficit. As expected, anosmia occurred in cases requiring bilateral resection of the olfactory epithelium. Postoperative imaging confirmed complete resection in all cases, and all patients demonstrated favorable recovery and short hospital stay.

Discussion: The transethmoidal transcribriform approach provides direct access to the anterior cranial fossa, permitting early devascularization and safe resection of tumors such as olfactory groove meningiomas, esthesioneuroblastomas, and sinonasal papillomas. Advantages include improved visualization, avoidance of brain retraction, superior cosmetic outcomes, and shorter recovery. Limitations involve tumor size >40 mm, extensive lateral extension, or involvement of the frontal sinus posterior table. The main complications are CSF leak and anosmia; however, risk decreases with surgical experience and advanced reconstruction techniques. This series demonstrates the feasibility, safety, and versatility of the approach in selected cases.

Conclusion: The endoscopic endonasal transethmoidal transcribriform approach is a safe and effective option for appropriately selected anterior cranial fossa tumors with sinonasal extension. Mastery of anatomical landmarks, meticulous dissection, and multilayered reconstruction are essential for minimizing complications. While certain limitations exist, this approach represents a valuable alternative to traditional open craniofacial procedures, providing comparable oncologic outcomes with reduced morbidity.

Keywords: anterior cranial fossa, endoscopic endonasal approach, transcribriform, transethmoidal, skull base surgery

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