RESUMO
INDICATIONS CORRIDORS AND LIMITS OF EXPOSURE: Subcranial approach is a versatile keyhole approach mainly indicated to the tumors of the anterior fossa and midline invasive tumors from the nasal cavity and paranasal sinus. 1-5 Endoscopic endonasal video assistance enhances the exposure and the safety of the approach. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT: Preoperative images depicted the size of the frontal sinuses and the relations of the lesions with frontal, ethmoid, and orbits. ESSENTIAL STEPS OF THE PROCEDURE: After performing a bifrontal scalp flap and a pericranial flap, periorbits are dissected from the superior and medial orbital rims. After frontonasal osteotomy, we drill the posterior wall of the frontal sinus. PITFALLS/AVOIDANCE OF COMPLICATIONS: Avoiding disruption of the cantal ligaments prevents telecantus. Watertight closure of the dura with temporal fascia graft and reinforcement with the pericranial flap makes cerebrospinal fluid leak occurrence very rare. VARIANTS AND INDICATIONS FOR THEIR USE: Subcranial approach is our preferred approach for the tumors of the anterior fossa floor and the midline paranasal invasive tumors. This keyhole approach through a relatively small frontoethmoidal craniotomy combines the advantages of the regular craniotomies but with no manipulation of the frontal lobes. An advantageous inferior angle of view similar of the pure endonasal endoscopical approach is achieved, but better than in the pure endoscopical approaches, the subcranial approach allows a direct wider exposure and a superior watertight reconstruction of the anterior fossa floor.The patients consented to the procedure and to the publication of his/her image.