SURGICAL APPROACHES TO THE ANTERIOR SKULL BASE

2016 ◽  
Author(s):  
Dimitrios Avgoustidis
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Surgical Approaches

Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures

2012 ◽  
Vol 32 (6) ◽  
pp. E3 ◽  
Author(s):  
Mateo Ziu ◽  
Jennifer Gentry Savage ◽  
David F. Jimenez
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Head Injuries ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Diagnosis And Management ◽  
Increased Risk ◽  
Technical Advances

Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition because of an increased risk of meningitis and brain abscess. Approximately 80% of all cases occur in patients with head injuries and craniofacial fractures. Despite technical advances in the diagnosis and management of CSF rhinorrhea caused by craniofacial injury through the introduction of MRI and endoscopic extracranial surgical approaches, difficulties remain. The authors review here the pathophysiology, diagnosis, and management of CSF rhinorrhea relevant exclusively to traumatic anterior skull base injuries and attempt to identify areas in which further work is needed.

Extended anterior subcranial approach for skull base tumors: long-term results

1995 ◽  
Vol 82 (6) ◽  
pp. 1002-1010 ◽  
Author(s):  
Joram Raveh ◽  
Jon B. Turk ◽  
Kurt Lädrach ◽  
Rolf Seiler ◽  
Nelson Godoy ◽  
...  
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Anterior Skull Base ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
En Bloc ◽  
Content Type ◽  
Anterior Cranial Base ◽  
Anterior Access

✓ The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical—otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival—sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

Glomangiopericytoma (sinonasal-type haemangiopericytoma)

2012 ◽  
Vol 126 (10) ◽  
pp. 1069-1072 ◽  
Author(s):  
J C Oosthuizen ◽  
S Kennedy ◽  
C Timon
Keyword(s):  
Skull Base ◽  
Endoscopic Resection ◽  
Clinical Presentation ◽  
Endoscopic Examination ◽  
Complete Resection ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Open Approach ◽  
Successful Management ◽  
Histopathological Features

AbstractBackground:Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours.Objective:Discussion of the clinical presentation, histopathological features and advances in the management of sinonasal and skull base glomangiopericytoma.Case report:A 32-year-old woman presented with worsening nasal obstruction, anosmia, severe frontal headaches and right-sided proptosis. Radiographic and endoscopic examination revealed a right-sided, vascular mass involving the nasal cavity, paranasal sinuses and anterior skull base. Histopathological features were consistent with a glomangiopericytoma. Complete endoscopic resection with free margins was achieved.Conclusion:Glomangiopericytomas are rare, vascular, sinonasal tumours. Successful management depends on complete resection, traditionally achieved via an open approach. However, recent advances in endoscopic surgical approaches have enabled complete endoscopic resection of these tumours, minimising morbidity and facilitating subsequent surveillance of the operative site.

Quality of life following endoscopic endonasal resection of anterior skull base cancers

2013 ◽  
Vol 119 (6) ◽  
pp. 1401-1409 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Davide Lepera ◽  
Mario Turri-Zanoni ◽  
Paolo Battaglia ◽  
Andrea Bolzoni Villaret ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Skull Base ◽  
Tertiary Care ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Partial Recovery ◽  
Endoscopic Endonasal ◽  
Significant Difference ◽  
Study Population

Object For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection. Methods The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy. Results One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p < 0.05). The specific symptoms and physical status domains registered poorer results at the 1-year assessment (4.00 and 4.71, respectively) than at the preoperative assessment (both domains 4.86), with a statistically significant reduction in scores (p < 0.05). Worse outcomes were associated with several variables: age > 60 years (difference of 0.21 points between the preoperative and 1-year period, p < 0.05), expanded surgical approaches with transnasal craniectomy (decrease of 0.20 points between the preoperative and 1-year period, p < 0.05), and postoperative radiotherapy (score of 4.53 at the 1-year period vs 4.70 in patients without any adjuvant treatment, p < 0.05). No statistically significant differences were found when analyzing the study population according to sex (p > 0.1) and T classification of disease at presentation (p > 0.05). Conclusions Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year.

scholarly journals The extended pterional approach for midline anterior skull base meningiomas

2020 ◽  
pp. 92-100
Author(s):  
Ahmed Nageeb Mohamed Taha ◽  
Hosam Shata Mohamed ◽  
Mahmoud Saad Mohamed
Keyword(s):  
Skull Base ◽  
Extent Of Resection ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Pterional Approach ◽  
Csf Rhinorrhea ◽  
Olfactory Groove ◽  
Effective Removal ◽  
Operative Notes ◽  
Skull Base Meningiomas

Background: Various surgical approaches for the management of midline anterior skull base meningiomas exist in the literature. The main surgeon target is proper selection the appropriate approach that achieves total removal of the lesion without causing morbidity or mortality and facilitates safe effective removal of the tumour. Objectives: To evaluate the role of the extended pterional approach for excision of midline anterior skull base meningiomas as regarding the effectiveness, extent of resection and surgical outcome. Patients and methods: This retrospective study involved 23 cases with midline anterior skull base meningiomas resected through the extended pterional approach. Patients' clinical data, operative notes, imaging studies and clinical follow-up data were analyzed and evaluated. Results: Tumors studied were 9 olfactory groove meningiomas, 8 tuberculum Sellae meningiomas, 4 planum sphenoidale meningiomas and 2 diaphragma sellae meningiomas. Gross total resection tumour excision in 15 cases (64.5%), subtotal excision in 5 cases (21.5%) and partial excision in 3 cases (14%). Complications were diabetes insipidus (2 cases 8.6%), CSF rhinorrhea (3 cases 12.9%) and visual deterioration (3 cases 12.9%). We had two cases of mortality. Conclusion: The extended pterional approach allows safe and effective removal of midline anterior skull base meningiomas. It expands the exposure offered by the classic pterional approach and minimizing the necessity for applying fixed brain retraction with good cosmetic outcome and less approach-related morbidities in comparison with the extensive skull base approaches.

scholarly journals Open Approaches to the Anterior Skull Base in Children: Review of the Literature

2018 ◽  
Vol 79 (01) ◽  
pp. 042-046 ◽  
Author(s):  
Ari DeRowe ◽  
Barak Ringel ◽  
Gadi Fishman ◽  
Dan Fliss ◽  
Oshri Wasserzug
Keyword(s):  
Skull Base ◽  
Endoscopic Surgery ◽  
Frontal Sinus ◽  
Skull Base Surgery ◽  
Pediatric Population ◽  
Developed Countries ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Endoscopic Skull Base Surgery ◽  
Skull Base Lesions

Introduction Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the “gold standard” for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases. Objective This article reviews current concepts and open approaches to the anterior skull base in children in the era of endoscopic surgery. Materials and Methods Comprehensive literature review. Results Extensive intracranial–intradural invasion, extensive orbital invasion, encasement of the optic nerve or the internal carotid artery, lateral supraorbital dural involvement and involvement of the anterior table of the frontal sinus or lateral portion of the frontal sinus precludes endoscopic surgery, and mandates open skull base surgery. The open approaches which are used most frequently for surgical resection of anterior skull base tumors are the transfacial/transmaxillary, subcranial, and subfrontal approaches. Reconstruction of anterior skull base defects is discussed in a separate article in this supplement. Discussion Although endoscopic skull base surgery in children is gaining popularity in developed countries, in many cases open surgery is still required. In addition, in developing countries, which accounts for more than 80% of the world's population, limited access to expensive equipment precludes the use of endoscopic surgery. Several open surgical approaches are still employed to resect anterior skull base lesions in the pediatric population. With this large armamentarium of surgical approaches, tailoring the most suitable approach to a specific lesion in regard to its nature, location, and extent is of utmost importance.

Combined Approach of the Anterior Skull Base in Sinonasal Tumours

2018 ◽  
Vol 69 (5) ◽  
pp. 1191-1193
Author(s):  
Dragos Octavian Palade ◽  
Bogdan Mihail Cobzeanu ◽  
Petronela Zaharia ◽  
Marius Dabija
Keyword(s):  
Skull Base ◽  
Surgical Techniques ◽  
Anterior Skull Base ◽  
Disease Stage ◽  
Surgical Approaches ◽  
Intracranial Extension ◽  
Combined Approach ◽  
Endoscopic Techniques ◽  
Complex Anatomy ◽  
Insidious Onset

Malignancies of the nasal cavity and the paranasal sinuses are rare, counting for less than 3 % of the ENT-cancers. The insidious onset of these tumours with non-specific symptoms often leads to a delayed diagnostic. Advanced disease stage combined with the complex anatomy of the sinonasal cavities and anterior skull base encouraged surgeons to extend beyond the boundaries the classic surgical techniques. Surgical approaches to anterior skull base lesions can be divided into open approches: craniofacial, subcranial, endoscopic techniques or combined approaches when a craniotomy is associated with an endonasal endoscopic approach. The indication must take into consideration the oncologic principles, histopathology exam, extent of disease and surgeon skill and experience. Combined approach should be taken into consideration for patients with extended disease or significant intraorbital or intracranial extension. For certain tumours that require a craniotomy for the superior, superolateral, and anterior extensions of the disease and also a nasal and paranasal sinus tumor that could be removed endoscopically, an endoscopic-assisted approach can be considered.

scholarly journals Expanded Endonasal Approaches to the Anterior Skull Base

2011 ◽  
Vol 3 (3) ◽  
pp. 176-183 ◽  
Author(s):  
Pornthep Kasemsiri ◽  
Matthew Old ◽  
Leo FS Ditzel Filho ◽  
Danielle de Lara ◽  
Daniel M Prevedello ◽  
...  
Keyword(s):  
Skull Base ◽  
Selection Criteria ◽  
Anterior Skull Base ◽  
Surgical Approaches ◽  
Olfactory Groove ◽  
Sinonasal Malignancies ◽  
Technological Advances ◽  
Cranial Fossa ◽  
Patient Selection Criteria ◽  
Ventral Skull Base

ABSTRACT Recent technological advances and growing cooperation between otorhinolaryngologists and neurosurgeons, coupled with an increasing knowledge of the anatomy of the ventral skull base, have led to the development of a series of surgical approaches to this region. Utilizing the nasal corridor, these expanded endonasal approaches (EEAs) benefit from the increased luminosity and definition provided by the endoscope to navigate through this corridor and reach a multitude o pathologies, both neoplastic and degenerative in nature. One of their common uses is to address tumors that arise from or invade the anterior cranial fossa; these lesions may include olfactory groove meningiomas, esthesioneuroblastomas and sinonasal malignancies. In order to safely resect these tumors through EEAs the surgical team must adhere to a series of steps, while planning the procedure as well as carrying it out. In this review article, the authors present these steps and describe the main patient selection criteria and complication avoidance strategies related to expanded endonasal approaches to the anterior skull base.

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