Complications in anterior cranial fossa surgery

The anterior cranial fossa is involved by many different disorders (such as benign tumors, malignancies, vascular abnormalities and even malformations) requiring different surgical strategies. Successfully dealing with the management of these disorders requires a deep anatomical knowledge of anterior cranial base and adjacent structure. Both transcranial and transnasal route could be used to resect different tumors. Many different aspects should be considered in the decision making process of the right surgical strategy according to different factors including extension, size, pathology, neurovascular involvement and previous radiation therapy. Here we briefly describe the basic anatomical landmarks and most common transcranial approaches to the anterior cranial fossa. Afterwards, we discuss complications commonly encountered in this surgery and our strategy in avoiding and eventually managing such complications. Finally we present “my worst case” as an exemplification of a complex case in which different transcranial and transnasal strategies have been applied.