Since the developments and popularization of modern skull base approaches through the twentieth century, surgical extirpation of tumors has become the mainstay of treatment for both benign and malignant diseases. Open and endoscopic approaches allow intradural and extradural tumor resection, and they can be performed in a single procedure that also allows precise reconstruction of the dura. Despite their technical reproducibility, however, these procedures still involve high risks for postoperative complications and mortality. Recent data show that over the last four decades, advancements in imaging modalities and refinements in surgical and reconstructive methods have allowed an increasing number of patients with skull base cancers to undergo curative surgical resections. Better understanding of skull base anatomy, the increasing experience of surgeons, and modifications of surgical techniques allow successful resections of complex skull base tumors involving multiple craniofacial compartments. As a result of improved preoperative imaging assessment, technical advances in tumor resection, new reconstruction methods, and the fruitful cooperation of multidisciplinary clinical teams, we have witnessed a decline in the rate of complications associated with skull base surgery.

The purpose of this chapter is to review the complications associated with skull base surgery in general and anterior skull base tumor resection specifically.