Zones of Approach for Craniofacial Resection: Minimizing Facial Incisions for Resection of Anterior Cranial Base and Paranasal Sinus Tumors

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1126-1137 ◽  
Author(s):  
James K. Liu ◽  
David Decker ◽  
Steven D. Schaefer ◽  
Augustine L. Moscatello ◽  
Richard R. Orlandi ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Paranasal Sinuses ◽  
Tumor Resection ◽  
Blind Spot ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Surgical Approaches ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base

Abstract OBJECTIVE Anterior cranial base tumors are surgically resected with combined craniofacial approaches that frequently involve disfiguring facial incisions and facial osteotomies. The authors outline three operative zones of the anterior cranial base and paranasal sinuses in which tumors can be resected with three standard surgical approaches that minimize transfacial incisions and extensive facial osteotomies. METHODS The zones were defined by performing dissections on 10 cadaveric heads and by evaluating radiographic images of patients with anterior cranial base tumors. The three approaches performed on each cadaver were transbasal, transmaxillary, and extended transsphenoidal. RESULTS Three zones of approach were defined for accessing tumors of the anterior cranial base, nasal cavity, and paranasal sinuses. Zone 1 is exposed by the transbasal approach, which is limited anteriorly by the supraorbital rim, posteriorly by the optic chiasm and clivus, inferiorly by the palate, and laterally by the medial orbital walls. This approach allows access to the entire anterior cranial base, nasal cavity, and the majority of maxillary sinuses. The limitation imposed by the orbits results in a blind spot in the superolateral extent of the maxillary sinus. Zone 2 is exposed by a sublabial maxillotomy approach and accesses the entire maxillary sinus, including the superolateral blind spot and the ipsilateral anterior cavernous sinus. However, access to the anterior cranial base is limited. Zone 3 is exposed by the transsphenoidal approach. This approach accesses the midline structures but is limited by the lateral nasal walls and intracavernous carotid arteries. An extended transsphenoidal approach allows further exposure to the anterior cranial base, clivus, or cavernous sinuses. The use of the endoscope facilitates tumor resection in the nasal cavity and paranasal sinuses. CONCLUSION The operative zones outlined offer minimally invasive craniofacial approaches to accessing lesions of the anterior cranial base and paranasal sinuses, obviating facial incisions and facial osteotomies. Case illustrations demonstrating the approach selection paradigm are presented.

Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

2010 ◽  
Vol 112 (1) ◽  
pp. 108-117 ◽  
Author(s):  
Bing Zhao ◽  
Yu-Kui Wei ◽  
Gui-Lin Li ◽  
Yong-Ning Li ◽  
Yong Yao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Preoperative Imaging ◽  
Surgical Removal ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base

Object The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus. Methods Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12–75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma. Results Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed. Conclusions The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.

Zones of Exposure in Surgical Approaches to the Anterior Cranial Base and Paranasal Sinuses

2003 ◽  
Vol 25 (25) ◽  
pp. 1-11
Author(s):  
William T. Couldwell ◽  
James K. Liu ◽  
Richard R. Orlandi ◽  
Martin H. Weiss
Keyword(s):  
Paranasal Sinuses ◽  
Cranial Base ◽  
Surgical Approaches ◽  
Anterior Cranial Base

scholarly journals Collision Occurrence of Sinonasal Carcinosarcoma and Pituitary Adenoma: A Case Report and Literature Review.

2020 ◽  
Author(s):  
Yufei Liu ◽  
Jihu Yang ◽  
Xiejun Zhang ◽  
Yanhua Sun ◽  
Fanfan Chen ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Large Mass ◽  
Cranial Base ◽  
Endonasal Approach ◽  
Ki 67 ◽  
Expanded Endonasal Approach ◽  
Anterior Cranial Base

Abstract BACKGROUND: Collision occurrences of sinonasal carcinosarcoma and pituitary adenoma are rarely reported. Sinonasal carcinosarcomas represent rare neoplasms with invasive characteristics and unfavorable prognoses.CASE DESCRIPTION: We present a rare case of a collision occurrence of sinonasal carcinosarcoma and pituitary adenoma in a 45‐year‐old male patient. MRI demonstrated a large mass involving the sellar region, nasal cavity, paranasal sinuses and anterior cranial base. Total surgical resection with a pure endoscopic expanded endonasal approach was performed successfully with neuronavigational assistance. Histopathologic results were a carcinosarcoma in the nasal cavity, paranasal sinuses, and anterior cranial base and a pituitary adenoma in the intrasellar zone. The Ki-67 index of the carcinosarcoma was high (more than 95%). Although the patient received chemotherapy, he died 6 months after surgery because of in situ recurrence and extensive metastatic growth.CONCLUSIONS: Collision occurrences of sinonasal carcinosarcoma and pituitary adenoma are rare events. Such tumor could be removed successfully by neuronavigational guidance with a pure endoscopic expanded endonasal approach. A contralateral nasal septum mucosa flap without tumor invasion can be used as a kind of skull base repair material. A high Ki-67 index may be a biomarker of rapid tumor progression and poor prognosis in such patients.

scholarly journals Endoscopic endonasal resection of midline cranial base tumors

2018 ◽  
Vol 19 (2) ◽  
pp. 7-17
Author(s):  
Enrico De Divitiis ◽  
Felice Esposito ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Oreste De Divitiis ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Visual Deficits ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base ◽  
Subtotal Removal

Objective: The advent of the endoscope in transsphenoidalsurgery has permitted to expand the indications of such approach also for the treatment of on tumors located in supra, para, retro and infrasellar regions, enabling the neurosurgeon to work under direct visual control in a minimally invasive way. Since 2004 we have started to use the extended endonasal transsphenoidal approach for a variety of lesions involving the midline skull base and, in particular, the suprasellar area, the cavernous sinus and the retroclival prepontine region. Methods: Over a 36-month period, sixty-four procedures have been performed. The series consisted of 29 males and 35 females, aged from 24 to 80 years (median 49.8 years). The mean follow-up was of 18 months (ranging from 3 to 36 months). Among the patients with midline lesions, who were 90.6 % of the total, seven patients had a pituitary adenoma, sixteen patients were affected by a craniopharyngioma, six patients had a suprasellar Rathke’s cleft cyst, seven subjects had a tuberculum sellae meningioma, four had an olfactorygroove meningioma, and six a clival tumor. Other lesions ofthe midline skull base were, 1 chiasmatic astrocytoma, 1 neuroendocrine tumor, 4 post-traumatic cerebro-spinal fluid rhinorrhea, and one optic nerve glioma. Three other patients had anterior cranial base meningoencephaloceles. Results: Overall, gross total removal of the lesion was achieved in 30/49 tumoral lesions (61.2%); subtotal removal was achieved in 12/49 cases (24.5%). The three cases of meningoencephaloceles were all successfully treated. Among the patients with preoperative visual deficits, most of them fully recovered or improved and only two worsened in one eye. Major complications consisted in 2 deaths (one not directly related with the surgical procedure), 6 postoperative CSF leak (one complicated with bacterial meningitis), one ICA injury, and 6 cases of permanent diabetes insipidus.Conclusion: The extended transsphenoidal approach tothe supra and parasellar lesions seems Endoscopy; Transsphenoidal surgery; Extended approach; Parasellar; Tumors; Anterior skull base. A promising minimally invasivetechnique for the removal of lesions affecting these areas,once thought to be suitable only of the transcranial routes.Concerning the lesion removal and the recurrence rate compared with the transcranial routes, it is too early to pose a definitive word, since the follow-up is still too short.

scholarly journals Morphofunctional State of the Maxillary Sinus Mucosa in Patients After Endoscopic Infundibulotomy

2021 ◽  
Vol 1 (3) ◽  
pp. 6-10
Author(s):  
Djuraev Jamolbek Abdukakharovich ◽  
◽  
Makhsitaliev Mukhammadbobur Ibrokhimovich, Ibrokhimovich ◽  
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Chronic Rhinosinusitis ◽  
Mucous Membrane ◽  
Paranasal Sinuses ◽  
Pathological Process ◽  
Fundamental Factor ◽  
Sinus Mucosa ◽  
Morphological State

The work carried out made it possible to substantiate the need to apply a method for studying the frequency of beating of cilia of the mucous membrane of the nasal cavity and paranasal sinuses in patients with chronic rhinosinusitis when choosing treatment tactics in an ENT hospital. Analysis of the study of data on the functional and morphological state of the mucous membrane of the nasal cavity and maxillary sinus allows us to judge the severity of the pathological process before surgery, which is the fundamental factor in the algorithm for the treatment of chronic rhinosinusitis.

Osteoblastoma of the nasal cavity invading the anterior skull base in a young child

1997 ◽  
Vol 87 (4) ◽  
pp. 625-628 ◽  
Author(s):  
Keisuke Imai ◽  
Kounosuke Tsujiguchi ◽  
Chiaya Toda ◽  
Ki-Chul Sung ◽  
Sadao Tajima ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Nasal Bone ◽  
Cranial Base ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
X Ray ◽  
Anterior Cranial Base ◽  
Radiological Images ◽  
Benign Osteoblastoma ◽  
Fine Print

✓ The benign osteoblastoma is rarely seen as a tumor of the facial bone in infancy or early childhood. Only five cases with nasal involvement have been reported in the literature. The authors present a case of osteoblastoma of the nasal cavity, the nasal bone, the ethmoid sinus, and the anterior cranial base. This 3-year-old girl presented with a tumor surrounding the left medial canthus. Imaging studies, including x-ray films, computerized tomography scans, magnetic resonance images, a 99mTc-scintigram, and angiograms, confirmed the location of the tumor. A biopsy specimen of tumor was obtained intranasally and the pathological diagnosis was an osteoblastic tumor suggestive of osteoblastoma. Although the tumor margin was well defined on the radiological images, it was difficult to determine the exact margin during the operation. Therefore, it is important to show how to excise the tumor completely under direct view. With the use of a “dismasking flap,” it was possible to resect the benign osteoblastoma completely from the nasal cavity, even though it extended into the orbit, the maxilla, and the anterior cranial base.

scholarly journals Pediatric Isolated Sinonasal Schwannoma: A New Case Report and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Xiao-Hui Ma ◽  
Hai-Chun Zhou ◽  
Can Lai ◽  
Kun Zhu ◽  
Xuan Jia
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Paranasal Sinuses ◽  
Pediatric Patients ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Group A

Schwannomas of the paranasal sinus are uncommon. Less than 4% of schwannomas involve the nasal cavity and paranasal sinuses, even less in the pediatric age group. A case of schwannoma arising in maxillary sinus in a 2.5-year-old Chinese boy is reported. The basis for discussion of this case is the exceptional rarity of sinonasal schwannoma in pediatric patients.

scholarly journals Maxillary Antrum Carcinoma - A Wolf in Sheep’s Clothing

2021 ◽  
Vol 10 (33) ◽  
pp. 2870-2873
Author(s):  
Romita Gaikwad ◽  
Pranada Deshmukh ◽  
Ramhari Sathawane ◽  
Ashish Lanjekar
Keyword(s):  
Nasal Cavity ◽  
Maxillary Sinus ◽  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Maxillary Antrum ◽  
Locally Advanced ◽  
Neck Region ◽  
Advanced Stage ◽  
Malignant Tumours ◽  
The Right

Maxillary sinus squamous cell carcinoma is an invasive tumour that is usually diagnosed at an advanced stage, where the majority of patients have a very low prognosis and survival rate. We present a case of maxillary sinus carcinoma that affected the entire orbit, resulting in proptosis of the eye and nasal cavity. The patient was recommended for palliative treatment due to the high degree of its involvement and proximity to vital structures. It manifests with very mild to no signs, resulting in a late diagnosis. As a result, physicians must be mindful of maxillary sinus pathologies to make an early diagnosis. Paranasal sinuses are air-filled spaces located close to vital structures such as visual organs and the face. Maxillary, ethmoidal, frontal, and sphenoidal are the 4 paranasal sinuses that are named according to the bones in which they are situated. Nasal cavity and paranasal air sinus malignancies are uncommon. According to the literature, paranasal sinus malignancies account for less than 1 % of all human malignancies and 3 % of the total malignancies of the head and neck region. However, the maxillary sinus is the most frequent site of origin of primary malignant tumours amongst the paranasal sinuses.1 we need to raise general awareness among the oral stomatologists as Asian countries report a very high incidence of maxillary sinus carcinoma.2 The incidence of malignancies in maxillary sinus is high (60 % - 70 %) and less in the nasal cavity (12 % - 25 %), the Ethmoid (10 % - 15 %) and very rare in sphenoid / frontal sinuses (1 %).3 Further, not only the malignancies of maxillary sinuses are common, but they also incur the worst prognosis. Maxillary sinus carcinomas have very few symptoms and are similar to those of chronic paranasal sinusitis. They usually present themselves as locally advanced diseases. 4,5 Paranasal sinus malignancies are difficult to diagnose in the early stages and 90 % of cases are reported in T3 / T4 advanced stage.6 Environmental factors such as industrial pollutants, dust, smoke, and adhesives are the leading causes for the development of disease.7 Thus, sinonasal malignant tumours are rare and pose a challenge in diagnosis as well as treatment. Therefore, maxillofacial specialists should be aware of the signs and symptoms of this rarely occurring disease. This article presents a rare case of a 45-year-old female who reported to our OPD with a complaint of swelling in the right zygomatic area and proptosis of the right eye.

scholarly journals Comparison between three techniques for videosinuscopy in cattle

2016 ◽  
Vol 46 (7) ◽  
pp. 1262-1267 ◽  
Author(s):  
Fernando Zanlorenzi Basso ◽  
Eduarda Maciel Busato ◽  
Jéssica Rodrigues da Silva ◽  
Rogério Luizari Guedes ◽  
Ivan Roque de Barros Filho ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Maxillary Sinus ◽  
Paranasal Sinuses ◽  
Frontal Sinus ◽  
Surgical Approaches ◽  
Endoscopic Anatomy ◽  
Flexible Colonoscope ◽  
Frontal Sinuses ◽  
Made In

ABSTRACT: Cattle have extensive paranasal sinuses that are susceptible to disease, most commonly sinusitis. The sinuscopy can be used to evaluate these structures, although there are no descriptions of this region for endoscopic anatomy, especially regarding the trocar position and the most appropriate type of endoscope. This study aimed to standardize the surgical approaches to sinuscopy in cattle by comparing the use of three endoscopes. Four accesses by trephination (one hole for each of the maxillary and frontal sinuses) were made in eight heads of slaughtered cattle. Each hole was inspected with three endoscopes: a 10mm flexible colonoscope with up to 180º of angulation, a 10mm 0° laparoscope and a 4mm 30º arthroscope. It was observed that all regions of the maxillary sinus were better visualized with the 4mm endoscope, and the structures of this sinus were less well visualized with the 10mm laparoscope. The frontal sinus was difficult to evaluate due to the tortuosity of its bony projections, and the cranial portion was not observed by the proposed accesses. The caudal regions of the frontal sinus such as the nuchal diverticulum and the back of the orbit had the greatest number of structures visualized by the 4mm endoscope, followed by the colonoscope. The comparative analysis showed that the 4mm endoscope was most efficient and could be adapted to sinuscopy in cattle.

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