Anterior cranial base surgery has been greatly enhanced with new advances in diagnostic and surgical techniques. These new advances incorporate a comprehensive, multidisciplinary approach to the removal of anterior skull-base lesions. Approaching the anterior cranial base from anterior and below has gained increasing popularity. The principal advantage is the minimal amount of frontal lobe retraction. In addition, this approach eliminates the need for facial incisions and therefore eliminates facial scarring. It also allows for the preservation of smell, depending on the location of the lesion, in contradistinction to more traditional techniques that often ensure anosmia. With the advent of improved endoscopic equipment and surgical techniques, endoscopic approaches have gained increased popularity in certain surgical cases as a different approach when compared with open surgical techniques.

Imaging plays an important role in the surgical and reconstructive planning of craniofacial tumors. It allows for assessment of the extent of the disease process and determination of the operability of the lesion. If the lesion is operable, the extent of the disease will also determine whether the surgical procedure is best done through an endoscopic or open approach. This chapter will focus on the open approach. The imaging modalities commonly employed include axial and coronal two-dimensional, three-dimensional, and interactive three-dimensional CT imaging, MR imaging, and angiography.