Cosmetic considerations in cranial base surgery

Recent advances in the surgical techniques for the resection of cranial base tumors have allowed for improved degrees of tumor resection, functional outcomes, and esthetic results. If the resection and functional results are not compromised by procedures providing excellent cosmetic outcomes, there is no reason to ignore or compromise the aesthetic aspect with regard to technical execution and planning. A thorough assessment of the patient's preoperative deficits and tumor anatomy, and a working knowledge of the available cranial base approaches and their combinations, permit the surgeon to design an approach that allows for optimal tumor resection with the best possible cosmetic result. Presented in this article is a discussion of the indications of the various cranial base approaches available and their combinations, with an emphasis on the skin incision used and the surgical techniques that facilitate a favorable aesthetic outcome.