The anterior cranial fossa is the most anterior and most superior of the three cranial fossae, supporting the frontal lobes and olfactory bulbs. It is formed by the orbital plates of the frontal bone laterally, the cribriform plate of the ethmoid centrally (transmitting olfactory filaments), and the lesser wings of the sphenoid and the planum sphenoidale posteriorly. The crista galli projects superiorly from the cribriform plate.
The anterior cranial fossa is the site of olfactory groove meningiomas (arising from the crista galli dura) and planum sphenoidale meningiomas that compress the olfactory nerves and optic chiasm, producing anosmia and visual deterioration. It is entered during transcranial frontal approaches to pituitary and suprasellar lesions. CSF rhinorrhea from cribriform plate fractures is managed endoscopically through this fossa. Anterior skull base trauma may rupture the olfactory filaments, causing post-traumatic anosmia.
Meningioma arising from the olfactory groove dura bilaterally compresses the olfactory bulbs (producing anosmia as the first symptom, often ignored) and eventually the optic nerves and frontal lobes, managed by bifrontal craniotomy or endoscopic endonasal approach with complete olfactory groove resection.
Anterior cranial fossa floor fracture through the cribriform plate tears the olfactory dura and mucosa, producing CSF rhinorrhea identified by glucose-positive clear nasal fluid, high-resolution CT confirmation, and observation for spontaneous closure or endoscopic repair if persistent.
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