Posterior skull base transfacial approaches.

Transfacial approaches to the midline skull base provide direct access for resection of complex lesions. The transfrontal nasal-orbital and transmaxillary (Levels III and V) approaches have become the "work horses" of our skull base team, in that either alone or in combination, they provide access to most parts of the anterior skull base and clivus. The flexibility offered by the ability to select a Level I or Level II approach in place of a Level III approach, or a Level VI approach in place of a Level V approach, however, greatly enhances the individualization of treatment strategy. The overlapping exposure shared by these techniques provides flexibility in the choice of surgical exposure and allows multiple factors to be considered, including tumor location and size.