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Proceedings of the Society of British Neurological Surgeons

HUW GRIFFITH and ROY ROUTLEDGE (Bristol) had devised a procedure which depended on two basic principles to achieve a safe complete resection of anterior skull base tumours which involve the dura mater. Firstly, the neurosurgeon who carried out the resection forsook the traditional route of an osteoplastic flap craniotomy above the level of the frontal air sinuses which virtually precluded the use by the repairing plastic surgeon of the well vascularised flexible skin of the forehead and scalp. The neurosurgeon, therefore, operated through a facial incision determined by the site of the growth, the resection being limited only by involvement of the cavernous sinuses and internal carotid artery. Second, when dural repair was necessary it was carried out by a sizable graft of fascia lata backed from the nasal cavity by the tip of a pedicle graft based on scalp or forehead. Using this technique for the repair they had operated on six cases without mortality, infection, or cerebrospinal fluid leakage, and had obtained complete resections of the tumour. Pain due to and infection around the tumour were eradicated. Three patients, after a worthwhile period lasting from one to three years, had since died from distant metastases.