The standard approach is a coronal incision. However, previous craniotomy incisions may also be utilized.
1. Subcranial approach
The subcranial access osteotomy is used to access the central compartment of the anterior cranial fossa.
Extradural dissection is performed in the central portion of the anterior cranial fossa around the cribriform plate. Division of the olfactory nerves is performed as needed.
The amount of the posterior dissection will depend on the extent and location of the defect. Elevation of the subfrontal dura from the planum sphenoidale can reach as far as the tuberculum sellae and the medial sphenoid ridge.