1 Anterior Cranial Fossa, Nasal Cavity, and Paranasal Sinuses

OBJECTIVEThe anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity.METHODSFive formalin-injected cadaveric specimens were used for this study (10 approaches). A classic pterional approach was performed. An OPC was created through the inferior orbital fissure, between the orbit and the PPF, by transposing the PPF inferiorly. The extent of the OPC was measured using neuronavigation and manual measurements. Two illustrative cases using the OPC to access skull base tumors are presented in the body of the article.RESULTSVia the OPC, the SphS, MaxS, ethmoid sinus (EthS), and nasal cavity could be accessed. The use of endoscopic assistance through the OPC achieved better visualization of the EthS, SphS, MaxS, clivus, and nasal cavity. A significant gain in the area of exposure could be achieved using the OPC compared to the AMT (22.4 mm2 vs 504.1 mm2).CONCLUSIONSOpening of the AMT and transposition of V2 and the contents of the PPF creates the OPC, a potentially useful deep keyhole to access the paranasal sinuses and clival region through a middle fossa approach. It is a valuable alternative approach to reach deep-seated skull base lesions infiltrating the cavernous sinus and middle cranial fossa and extending into the paranasal sinus.

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Recurrent epistaxis as manifestation of renal cell carcinoma sinonasal metastasis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh181231035f ◽

2019 ◽

Vol 147 (5-6) ◽

pp. 364-367

Author(s):

Miljan Folic ◽

Aleksandar Trivic ◽

Bojan Pavlovic ◽

Ivan Boricic ◽

Jovica Milovanovic

Keyword(s):

Renal Cell Carcinoma ◽

Nasal Cavity ◽

Cell Carcinoma ◽

Renal Cell ◽

Malignant Disease ◽

Renal Carcinoma ◽

Radiological Examination ◽

Anterior Cranial Fossa ◽

Recurrent Epistaxis ◽

Cranial Fossa

Introduction. Renal cell carcinoma is the most frequent infraclavicular primary tumor metastasizing in the sinonasal region, although these metastases are not common. We present an unusual case of recurrent epistaxis as the initial sign of renal carcinoma sinonasal metastasis and discuss the diagnostic and treatment options. Case outline. A 66-year-old patient was admitted to the hospital due to recurrent and severe epistaxis. The patient underwent nephrectomy due to renal cell carcinoma, with no signs of relapse during a three-year follow-up. Nasal endoscopy and computed tomography revealed a large mass in nasal cavity, spreading to the anterior and posterior ethmoid cells, sphenoid sinus, orbit, and anterior cranial fossa. Definite diagnosis of renal cell carcinoma metastasis in sinonasal region was made by a pathologist after biopsy and further radiological examination showed no signs of malignant disease in the abdomen, thorax, or pelvis. Although the patient had received 50 Gy of radiation therapy, the malignant disease was evaluated as progressive with further extension in anterior cranial fossa and maxilla, and the patient died five months after the occurrence of epistaxis. Conclusion. In patients with recurrent epistaxis who also had a history of renal carcinoma, endoscopic finding of tumefaction in the nasal cavity should raise a suspicion of sinonasal metastasis. In such cases, biopsy is mandatory to differentiate a metastasis from primary sinonasal tumors. Histological confirmation should be followed by radiological examination of the abdomen, thorax, and pelvis to evaluate the possibility of renal cell carcinoma recurrence or metastatic dissemination elsewhere.

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Fulminant presentation of a SMARCB1-deficient, anterior cranial fossa tumor in adult

Surgical Neurology International ◽

10.25259/sni_171_2020 ◽

2020 ◽

Vol 11 ◽

pp. 195

Author(s):

Idan Levitan ◽

Suzana Fichman ◽

Yosef Laviv

Keyword(s):

Skull Base ◽

Paranasal Sinuses ◽

Anterior Skull Base ◽

Anterior Cranial Fossa ◽

Sinonasal Carcinoma ◽

Rhabdoid Cells ◽

Atypical Teratoid ◽

Cranial Fossa ◽

Rhabdoid Glioblastoma ◽

Tumor Debulking

Background: Malignant atypical teratoid rhabdoid tumor (ATRT) usually develops in children. ATRTs are rare in adults, with only one case in the literature describing involvement of the anterior skull base. These primary intracranial tumors are characterized molecularly as SMARCB1 (INI1) deficient. Different types of such SMARCB1-deficient tumors exist in adulthood, usually in the form of extracranial tumors. Very few cases of such a new entity, named SMARCB1-deficient sinonasal carcinoma have been described with intracranial penetration and involvement of the anterior cranial fossa. Case Description: A 36-year-old male presented with acute cognitive deterioration. Over few hours, he developed a fulminant herniation syndrome. Imaging showed a tumor in the anterior cranial fossa surrounded by massive brain edema. The tumor has destroyed the frontal bone with involvement of the nasal cavities and paranasal sinuses. The patient underwent emergent decompressive craniectomy and tumor debulking but could not be saved. Pathological analysis revealed a highly cellular tumor without rhabdoid cells but with areas of necrosis. Further immunohistochemical stains revealed that neoplastic cells were diffusely and strongly positive for epithelial membrane antigen and P63 and negative for SMARCB1 (i.e., loss of expression), confirming the diagnosis of sinonasal carcinoma. Conclusion: To the best of our knowledge, this is the first report of a fulminant presentation of a SMARCB1- deficient tumor in young adult, involving the anterior cranial fossa and the paranasal sinuses. The main differential diagnosis of aggressive, primary, intracranial SMARCB1-deficient tumors in adults includes ATRT, SMARCB1- deficient sinonasal carcinoma, rhabdoid meningioma, and rhabdoid glioblastoma. Atypical tumors involving the anterior skull base without a clear histopathological pattern should therefore be checked for SMARCB1 expression.

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Rhinotomy Approaches to the Paranasal Sinuses and Anterior Skull Base

Otolaryngology ◽

10.1016/s0194-5998(05)80135-4 ◽

1995 ◽

Vol 112 (5) ◽

pp. P63-P63

Author(s):

William Lawson ◽

Anthony J. Reino

Keyword(s):

Skull Base ◽

Paranasal Sinuses ◽

Anterior Skull Base ◽

Anterior Cranial Fossa ◽

Malignant Diseases ◽

Educational Objectives ◽

Cranial Fossa

Educational objectives: To understand and apply the three rhinotomy approaches for extirpation of benign and malignant diseases of the sinonasal cavity, skull base, and anterior cranial fossa.

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Transcranial–facial Approach for Tumours of Superior Paranasal Sinuses and Orbit

Journal of the Royal Society of Medicine ◽

10.1177/014107688007300605 ◽

1980 ◽

Vol 73 (6) ◽

pp. 413-419 ◽

Cited By ~ 7

Author(s):

Peter Clifford

Keyword(s):

Paranasal Sinuses ◽

Malignant Disease ◽

Disease Recurrence ◽

Anterior Cranial Fossa ◽

Results Of Treatment ◽

Cranial Fossa

A monobloc resection of the fronto-ethmoid sphenoid area may be performed through a combined cranial and facial approach. Osmotic cerebral dehydration increases the exposure of the anterior cranial fossa. The results of treatment in 26 patients (24 with malignant disease of the ethmoid area who had disease recurrence after previous radiotherapy with or without surgery) and the complications encountered are described. The clinical details of 9 of these patients have been included in an earlier report (Clifford 1977).

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Anterior Craniofacial (Transcranial) Resection for Tumors of Nose and Paranasal Sinuses: Surgical Technique

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1081 ◽

2011 ◽

Vol 3 (3) ◽

pp. 197-201

Author(s):

Saurabh Varshney ◽

SS Bist ◽

Sarita Mishra ◽

Charitesh Gupta ◽

Sanjiv Bhagat ◽

...

Keyword(s):

Paranasal Sinus ◽

Paranasal Sinuses ◽

Malignant Tumors ◽

Cribriform Plate ◽

Anterior Cranial Fossa ◽

Craniofacial Resection ◽

Csf Leakage ◽

Cranial Fossa ◽

The Mean ◽

Nose And Paranasal Sinuses

ABSTRACT Background Management of nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Anterior craniofacial resection is recognized as the best treatment for nose and paranasal sinus, tumors involving the cribriform plate with or without invasion of anterior cranial fossa. Craniofacial resection allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. Methods Twenty-one patients underwent anterior craniofacial resection for nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa at Himalayan Institute of Medical Sciences, Dehradun between 2000 and 2011 by a team of head-neck surgeons and neurosurgeons. Results The series included 16 malignant tumors of the nose and paranasal sinuses and five extensive benign lesions. The mean age was 47.4 years (range, 12 to 68 years). There were 16 men and five women (M:F- 3.2:1.0). Four patients had a recurrence after previous treatments (surgery and/or radiotherapy). The histological subdivision was as follows: Seven cases of squamous cell carcinoma, four cases of adenocarcinoma, three cases of esthesioneuroblastoma, and two cases of undifferentiated tumors. All tumors were resected by a combined bifrontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of CSF-leakage or meningitis, two patients had wound infection. Recurrent tumor growth or systemic metastasis occurred in three (18.75%) out of 16 patients with malignant tumors, 6 months to 2 years postoperatively. The mean follow-up was 16 months. Conclusion An anterior craniofacial resection should be performed in cases of nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa.

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