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.

Combined endoscopy-assisted cranionasal approach for resection of infantile myofibromatosis of the ethmoid and anterior skull base

2008 ◽  
Vol 2 (1) ◽  
pp. 58-62 ◽  
Author(s):  
Ercole Galassi ◽  
Ernesto Pasquini ◽  
Giorgio Frank ◽  
Gianluca Marucci
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Radical Resection ◽  
Permanent Tooth ◽  
Anterior Skull Base ◽  
Facial Growth ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Endoscopic Techniques ◽  
Tooth Roots

The advent and widespread development of endonasal endoscopic techniques have recently expanded the frontiers of skull base surgery. The reduced invasiveness, wider and adjustable visualization of the operative field, and lack of postoperative cosmetic defects are well-known advantages of the endonasal endoscopic approaches compared with traditional surgical exposures both in adults and in children. The need to avoid disruption of facial growth centers and permanent tooth roots represents a further special consideration in favor of these endoscopic techniques in children. The authors report on a case of solitary myofibroma involving the ethmoid, mesial orbits, and anterior skull base with intracranial intradural expansion in a 17-month-old girl. The occurrence of such proliferative disease along the skull base is exceedingly rare. The tumor was successfully excised via an endoscopy-assisted cranionasal approach in which a transcranial microsurgical exposure was combined with endonasal endoscopic access to ensure a radical resection and optimize skull base reconstruction. To the authors' knowledge, the patient in this case is the youngest reported patient in the literature who has undergone treatment with this surgical strategy. The outcome in this patient underscores the feasibility and safety of endoscopic endonasal surgery even in toddlers and early childhood.

Averting Delayed Complications of Open Anterior Skull Base Surgery

2020 ◽  
Author(s):  
Barak Ringel ◽  
Nir Livneh ◽  
Narin N. Carmel-Neiderman ◽  
Gilad Horowitz ◽  
Nevo Margalit ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Surgical Techniques ◽  
Treatment Protocol ◽  
Anterior Skull Base ◽  
Multidisciplinary Teams ◽  
Level Of Evidence ◽  
Reconstructive Procedures ◽  
Female Ratio ◽  
Delayed Complications

Abstract Objectives Despite its technical feasibility, anterior skull base surgery still carries the risk of severe postoperative complications, morbidity, and mortality. The reported rate of complications has diminished over the past two decades, but they continue to pose various challenges. This study aims to report late complications in a relatively large series of patients who underwent open anterior skull base surgery, and to propose methods for averting such complications. Methods Retrospective chart review of all patients who underwent anterior open skull base surgery between 2000 and 2016 in a university-affiliated tertiary referral cancer center. Results There were 301 operations, of which 198 (65.8%) were for benign disease and 103 (34.2%) were for malignant tumors. The male-to-female ratio was 1.4:1, and the mean age was 44.8 years. Delayed complications occurred in 85 patients (28.2%): 31 (10.3%) involved wounds, 18 (13.9%) involved the central nervous system, and 14 (4.6%) involved the orbit. Multivariate analysis found malignant pathology, intracranial extension, and previous radiochemotherapy as predictors for the development of a delayed complication. The patients who were operated in the later study period (after 2007) had lower rates of all three types of complications compared with the earlier study period. Conclusion Delayed complications following skull base surgery are in decline. This is mainly due to the advancement in imaging studies, surgical techniques, development of sophisticated reconstructive procedures, and the cooperation of multidisciplinary teams. We attribute the reduction in our department to our revised treatment protocol which is presented herein, with emphasis on averting the occurrence of these complications. Level of Evidence The level of evidence is 4.

Reconstruction of the Anterior Skull Base following a Craniofacial Combined Approach

2015 ◽  
pp. 615-618
Author(s):  
Haruo Sakai ◽  
Norio Nakamura ◽  
Shozo Kaneko
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Combined Approach

scholarly journals Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica

2005 ◽  
Vol 19 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Amin Kassam ◽  
Carl H. Snyderman ◽  
Arlan Mintz ◽  
Paul Gardner ◽  
Ricardo L. Carrau
Keyword(s):  
Skull Base ◽  
Sella Turcica ◽  
Surgical Techniques ◽  
Case Series ◽  
Anterior Skull Base ◽  
Anatomical Landmarks ◽  
Endonasal Approach ◽  
Appropriate Use ◽  
Expanded Endonasal Approach ◽  
Skull Base Lesions

Object Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. More recently, the standard endonasal approach has been expanded to provide access to other, parasellar lesions. With the addition of the endoscope, this expansion carries significant potential for the resection of skull base lesions. Methods The anatomical landmarks and surgical techniques used in expanded (extended) endoscopic approaches to the rostral, anterior skull base are reviewed and presented, accompanied by case illustrations of each segment (or module) of approach. The rostral half of the anterior skull base is divided into modules of approach: sellar/parasellar, transplanum/transtuberculum, and transcribriform. Case illustrations of successful resections of lesions with each module are presented and discussed. Conclusions Endoscopic, expanded endonasal approaches to rostral anterior skull base lesions are feasible and hold great potential for decreased morbidity. The effectiveness and appropriate use of these techniques must be evaluated by close examination of outcomes as case series expand.

scholarly journals Extracranial ligation of ethmoidal arteries before resection of giant olfactory groove or planum sphenoidale meningiomas: 3 illustrative cases with a review of the literature on surgical techniques

2013 ◽  
Vol 35 (6) ◽  
pp. E13 ◽  
Author(s):  
Sunil Manjila ◽  
Efrem M. Cox ◽  
Gabriel A. Smith ◽  
Mark Corriveau ◽  
Nipun Chhabra ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Techniques ◽  
Anterior Skull Base ◽  
Preoperative Embolization ◽  
Imaging Data ◽  
Olfactory Groove ◽  
Surgical Ligation ◽  
Ethmoidal Arteries ◽  
Planum Sphenoidale ◽  
Skull Base Meningiomas

Object There are several surgical techniques for reducing blood loss—open surgical and endoscopic—prior to resection of giant anterior skull base meningiomas, especially when preoperative embolization is risky or not technically feasible. The authors present examples of an institutional experience using surgical ligation of the anterior and posterior ethmoidal arteries producing persistent tumor blush in partially embolized tumors. Methods The authors identified 12 patients who underwent extracranial surgical ligation of ethmoidal arteries through either a transcaruncular or a Lynch approach. Of these, 3 patients had giant olfactory groove or planum sphenoidale meningiomas. After approval from the institution privacy officer, the authors studied the medical records and imaging data of these 3 patients, with special attention to surgical technique and outcome. The variations of ethmoidal artery foramina pertaining to this surgical approach were studied using preserved human skulls from the Hamann-Todd Osteological Collection at the Museum of Natural History, Cleveland, Ohio. Results The extracranial ligation was performed successfully for control of the ethmoidal arteries prior to resection of hypervascular giant anterior skull base meningiomas. The surgical anatomy and landmarks for ethmoidal arteries were reviewed in anthropology specimens and available literature with reference to described surgical techniques. Conclusions Extracranial surgical ligation of anterior, and often posterior, ethmoidal arteries prior to resection of large olfactory groove or planum sphenoidale meningiomas provides a safe and feasible option for control of these vessels prior to either open or endoscopic resection of nonembolized or partially embolized tumors.

scholarly journals Application of hybrid cranioendoscopic approaches in anterior skull base surgery

2020 ◽  
Vol 2 (2) ◽  
pp. V5
Author(s):  
Evan Joyce ◽  
Michael Karsy ◽  
Serge Makarenko ◽  
Gretchen M. Oakley ◽  
William T. Couldwell
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Surgical Techniques ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Link Type ◽  
Skull Base Defect ◽  
Base Lesion

Anterior skull base approaches have included endoscopic or open microsurgical approaches for intracranial pathologies. However, discussion of a combined hybrid, cranioendoscopic approach, leveraging the benefits of both techniques, has been limited. Here we describe a case of a combined endoscopic, endonasal, and open microsurgical frontotemporal approach for resection of a complex anterior skull base lesion. A 62-year-old man with a large meningioma extending intradurally through the cribiform plate and sphenoethmoidal sinuses underwent a cranioendoscopic resection. Surgical techniques, including repair of the anterior skull base defect as well as complication avoidance and the coordination of multiple surgeons, are discussed.The video can be found here: https://youtu.be/Ti9tUUdWgJc.

scholarly journals Skull base highways

2017 ◽  
Vol 7 (3) ◽  
pp. 5-16
Author(s):  
Ossama Al-Mefty ◽  
Luis A.B. Borba
Keyword(s):  
Skull Base ◽  
Surgical Procedure ◽  
Skull Base Surgery ◽  
Surgical Techniques ◽  
Morbidity And Mortality ◽  
Surgical Approaches

With the advances in the field of the skull base surgery, lesions previously considerated inoperable can now be approched and treated successfully. Because of the increased interested by the neurosurgical community in the anatomy and surgical approaches to the skull base, a new neurosurgical specialty is forming. However, to perform a safe surgical procedure with low morbidity and mortality, the neurosurgeon must gain experience in surgical approaches to the skull base. In this report, we describe the steps and illustrate with artists renderings the following skull base approaches: the cranioorbito-zygomatic, the zygomatic infratemporal, the petrosal, the transcodidylar and the transmaxillary. We also discuss the indications for and limitations of each approach. We encourage neurosergeons to explore this field to carefully study the anatomy and surgical techniques presented in this report.

scholarly journals Anterior Skull Base Glomangioma-Induced Osteomalacia

2017 ◽  
Vol 78 (01) ◽  
pp. e9-e11 ◽  
Author(s):  
Malia Gresham ◽  
Steven Shen ◽  
Yi Zhang ◽  
Kelly Gallagher
Keyword(s):  
Skull Base ◽  
Paranasal Sinus ◽  
Complete Resolution ◽  
Ethmoid Sinus ◽  
Anterior Skull Base ◽  
Intracranial Extension ◽  
Endoscopic Endonasal Approach ◽  
Oncogenic Osteomalacia ◽  
Endoscopic Endonasal ◽  
Mesenchymal Neoplasms

AbstractOncogenic osteomalacia (OO) is an uncommon but treatable cause of osteomalacia related to tumor production of FGF23, usually caused by benign mesenchymal neoplasms. Paranasal sinus glomangiomas are a rare cause of OO, with only one previously reported case. Here we describe a second case (first reported in English) of paranasal sinus glomangioma-induced osteomalacia in a 42-year-old man. He presented with weakness and multiple spontaneous fractures, and was found to have an ethmoid sinus glomangioma with intracranial extension. The tumor was removed via endoscopic endonasal approach to the anterior skull base, which resulted in complete resolution of symptoms and no further evidence of disease 1 year postoperatively.

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