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Effective and safe treatment of lesions involving the anterior skull base and brain depends on several factors, including a careful clinical history, preoperative evaluation and imaging studies, familiarity with regional anatomy and cerebrovascular physiology, and refined surgical technique.

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Technologic advances such as image-guided systems and enhanced endoscopic surgical techniques and equipment have facilitated approaches to the anterior skull base and brain, optimizing the surgical exposure and reducing the risk of complications while avoiding extensive brain retraction and nerve damage.

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Use of a multidisciplinary team approach has increased survival and decreased complication rates from skull base surgery, and this type of surgery is contraindicated without such a team. The multidisciplinary team should include neurosurgery, otolaryngology, anesthesiology, pathology, endocrinology intensive care, and paramedical staff, familiar with the care of patients at risk for significant neurologic sequelae.

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The development of new reconstruction techniques for closing dural defects has been assisted by the use of pedicled nasal septal flaps and has enabled more extensive resections and reduced complication rates. However, infection, cerebrospinal fluid leakage, and difficulty controlling intradural bleeding still present a challenge, and a frank discussion of the risk of these problems is essential for the patient to give informed consent.