Open transnasal approach to the midline skull base.

Surgical access to the anterior skull base for resection of midline tumors is commonly performed through a transfacial approach. We describe a new, open transnasal approach to the midline skull base and adjacent pituitary region. This technique, devised through our experience with open septorhinoplasty, was initially studied on fresh cadaver heads. It has subsequently been used in 28 consecutive patients for the resection of a variety of midline skull base tumors. We believe that this approach is superior to the traditional rhinal and sublabial transfacial techniques because of the wider exposure and true midline orientation that it offers. In addition, no mucosal membrane is violated, therefore providing a greater seal of the dissection postoperatively. A detailed description of the technique and the results of its clinical use are presented.