{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T14:03:46Z","timestamp":1772892226805,"version":"3.50.1"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003The transbasal approach traditionally uses a bicoronal scalp incision with bifrontal craniotomy to establish an extradural midline skull base working corridor. Depending on additional craniofacial osteotomies, this approach can expand its reach to the nasal cavity and paranasal sinuses and may be employed for the resection of particularly complex sinonasal and midline skull base tumors. Given its discrepancy in nomenclature and differences in interoperator technique, we propose a practical, operatively oriented guide for trainees performing this approach.<\/jats:p><jats:p>\n          Methods\u2003Three formalin-fixed, latex-injected specimens were dissected under microscopic magnification and endoscopic-assisted visualization. Stepwise dissections of the transcranial-transbasal approach with common modifications were performed, documented with three-dimensional photography, and supplemented with representative case applications.<\/jats:p><jats:p>\n          Results\u2003The traditional transbasal approach via bifrontal craniotomy affords wide extradural access to the anterior cranial fossa and central skull base. The addition of craniofacial osteotomies further expands access into the sinonasal cavities, clivus, and craniocervical junction. Key steps described include patient positioning, bicoronal skin incision, pericranial graft harvest, bifrontal craniotomy, orbital rim osteotomy, sphenoidotomy, bilateral ethmoidectomies, and microsurgical dissection of the sellar region. Basal superior sagittal sinus ligation and durotomy allow for intradural exposure. Reconstruction techniques are also discussed.<\/jats:p><jats:p>\n          Conclusion\u2003While the transbasal approach is rich with historical descriptions, illustrations, and modifications, its stepwise performance may be relatively unknown and unclear to younger generations of trainees. We present a comprehensive guide to optimize familiarity with the transbasal approach and its indications in the surgical anatomy laboratory, mastery of the relevant microsurgical anatomy, and simultaneous preparation for learning and participation in the operating room.<\/jats:p>","DOI":"10.1055\/s-0043-1775875","type":"journal-article","created":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T23:22:31Z","timestamp":1696893751000},"page":"596-605","source":"Crossref","is-referenced-by-count":2,"title":["Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Bifrontal Transbasal Approach, Surgical Principles, and Illustrative Cases"],"prefix":"10.1055","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-8614","authenticated-orcid":false,"given":"Larissa","family":"Vilany","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5004-1033","authenticated-orcid":false,"given":"Danielle D.","family":"Dang","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6463-5000","authenticated-orcid":false,"given":"Edoardo","family":"Agosti","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3435-6083","authenticated-orcid":false,"given":"Pedro","family":"Plou","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Hospital Italiano de Buenos Aires, Buenos Aires, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8066-4055","authenticated-orcid":false,"given":"Luciano C. P. C.","family":"Leonel","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Graepel","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3921-4658","authenticated-orcid":false,"given":"Carlos D.","family":"Pinheiro-Neto","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-465X","authenticated-orcid":false,"given":"Giuseppe","family":"Lanzino","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9189-303X","authenticated-orcid":false,"given":"Maria","family":"Peris-Celda","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,10,9]]},"reference":[{"key":"ref1","first-page":"427","volume-title":"Transbasal approach to tumors invading the skull base","author":"P Derome","year":"1993","edition":"4th ed."},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/00000658-191302000-00001","article-title":"An approach to the hypophysis through the anterior cranial fossa","volume":"57","author":"C H Frazier","year":"1913","journal-title":"Ann Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"22444","DOI":"10.1038\/s41598-020-80255-8","article-title":"The transbasal approach to the anterior skull base: surgical outcome of a single-centre case series","volume":"10","author":"A K Aftahy","year":"2020","journal-title":"Sci Rep"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.3171\/jns.1991.74.6.1011","article-title":"An extensive transbasal approach to frontal skull-base tumors. 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