The Transglabellar/Subcranial Approach to the Anterior Skull Base (original) (raw)
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Skull Base, 2011
We analyzed the effect of predefined patient demographic, disease, and perioperative variables on the rate of complications in the perioperative period following subcranial surgery for anterior skull base lesion. A secondary goal of this study was to provide a benchmark rate of perioperative mortality and morbidity through comprehensive analysis of complications. Retrospective review of a consecutive series of patients (n ΒΌ 164) who underwent the transglabellar/subcranial approach to lesions of the anterior skull base between December 1995 and November 2009 in a tertiary referral center. Main outcome measures were perioperative morbidity and mortality. No perioperative mortalities were observed over the period of consecutive review. The overall complication rate was 28.7%, with 30 (18%) patients experiencing major complication. Multivariate analysis revealed that the following variables were independent predictors of perioperative complication of any type: positive margins on final pathology, perioperative lumbar drain placement, and dural invasion. The subcranial approach provides excellent access to the anterior skull base with zero mortality and acceptable morbidity in comparison with other contemporary open surgical approaches. It should be considered a procedure with distinct advantages in terms of perioperative morbidity and mortality when selecting a therapeutic approach for patients with anterior skull base lesions.
Craniofacial Resection: Decreased Compl ication Rate with a Modified Subcranial Approach
Skull Base, 1999
Cran iofacial Resection: Decreased Compl ication Rate with a Modified Subcranial Approach Craniofacial approaches have become the procedures of choice for most tumors, trauma, and congenital anomalies involving the anterior cranial fossa and the orbits, nasal cavity, or paranasal sinuses. However, recent reports continue to document a complication rate of 39-50% and a mortality of 3-5% with these procedures,I prompting some authors to state that they are too morbid for routine use.2 We have used a modified subcranial approach for a variety of lesions at the anterior cranial base and have achieved a lower complication rate than previously reported. We report our technique and results in 31 consecutive cases. MATERIALS AND METHODS This series consists of 31 consecutive patients operated upon over a 4-year period by the authors. Patients were evaluated in a multidisciplinary clinic staffed by a team representing the neurosurgery, otorhinolaryngology, and neuro-otology disciplines. Patients were considered appropriate for a subcranial approach when they had tumors, trauma, or congenital anomalies for which surgery was indicated and that anatomically involved the face, orbit(s), nasal cavity, and/or paranasal sinuses 95
Early outcome and complications of the extended subcranial approach to the anterior skull base
The Laryngoscope, 1999
To present the technique of the extended subcranial approach to the anterior skull base and to review the results in 55 patients who underwent the procedure. Retrospective review of the records of 55 patients who underwent the extended subcranial approach to the anterior skull base between 1994 and 1998 for the treatment of various neoplasms originating in the nasal cavity, nasopharynx, paranasal sinuses, orbit, or meninges, as well as for the repair of complex craniofacial trauma and/or cerebrospinal fluid (CSF) leak. Preoperative patient evaluation and the surgical technique are also reviewed. Patient records were retrospectively reviewed and tabulated for age, sex, and indications for procedure, with special focus on early outcome and complications. Twenty-six patients underwent oncologic resections, 22 patients had reduction of complex fronto-naso-orbital and skull base fractures, and seven patients had repair of CSF leak. Significant complications in the oncologic group consisted of one hematoma requiring needle aspiration and two cases of temporary nontension pneumocephalus. In the fracture group, one patient died because of extensive intracerebral damage and multiorgan failure, and one patient had nontension pneumocephalus coupled with CSF leakage and one patient had temporary nontension pneumocephalus. The most common late complication in all three groups was anosmia. Based on their review, the authors conclude that the extended subcranial approach to the anterior skull base is a safe, versatile, and effective procedure for the surgical treatment of various pathological conditions involving the anterior skull base.
Craniofacial resection for lesions involving anterior base of skull
1996
Craniofacial resection represents a major advance in the surgical treatment of tumours of the paranasal sinuses. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumour resection. The development of computerised tomography has improved patient selection for surgery. The present study analyses results of craniofacial resection in 30 patients, 19 of whom had malignant tumours. Fourteen of these cases are disease-free after periods of 6 to 36 months. Eleven other patients had extensive benign lesions. A satisfactory reduction of proptosis and relief from other symptoms was obtained in all cases in the benign group. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumours of anterior skull base.
Neurosurgery, 2006
Objective: During the past decade, applications of anterior and anterolateral cranial approaches for both benign and malignant pathologies have expanded in frequency and application. Complications associated with these procedures impact significantly on patient outcome. The primary aim of this study is to detail the strategies for complication management and avoidance developed from experience with 120 patients who underwent anterior and anterolateral cranial base procedures during the past 14 years. Methods: Between July 1990 and February 2004, 62 male and 58 female patients underwent 120 combined (neurological surgery and otolaryngology joint participation) anterior and anterolateral cranial base procedures. Fifty-four percent had malignant pathology, and 46% had benign pathology. The approaches taken were transfacial (10%), extended subfrontal (33%), lateral craniofacial (23%), and anterior craniofacial (35%). Thirty-day morbidity and mortality were analyzed. Results: Twenty (17%...
Complications of Skull Base Surgery: An Analysis of 30 Cases
Skull Base, 2008
Objectives: To evaluate the risk factors for perioperative complications among patients undergoing craniofacial resection for the treatment of skull base tumors. Design: Retrospective analysis. Participants: The study group comprised 29 patients with skull base tumors (22 malignant and 7 benign) who underwent 30 craniofacial resections at Hokkaido University Hospital between 1989 and 2006. Of these cases, 21 had undergone prior treatment by radiation (16 cases), surgery (7 cases), or chemotherapy (1 case). Moreover, 19 needed extended resection involving the dura (11 cases), brain (5 cases), orbit (12 cases), hard palate (5 cases), skin (3 cases), or cavernous sinus (2 cases). Main outcome measures: Perioperative complications and risk factor associated with their incidence. Results: Perioperative complications occurred in 12 patients (40%; 13 cases). There was a significant difference between complication rates for cases with and without prior therapy (52.4% vs. 11.1%). The complication rate for dural resection cases was 81.8%. There was a significant difference between complication rates for cases with and without dura resection. No postoperative mortality was reported. Conclusions: Craniofacial resection is a safe and effective treatment for skull base tumors. However, additional care is required in patients with extended resection (especially dural) and those who have undergone prior therapy.
Anterior craniofacial resection 01
Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the "gold standard" for surgery is the anterior craniofacial approach. Craniofacial resection represents a major advance in the surgical treatment of tumors of the paranasal sinuses involving anterior skull base. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. This study presents a series of 18 patients with anterior skull base tumors, treated by a team of head-neck surgeons and neurosurgeons. The series included 15 malignant tumors of the nose and paranasal sinuses and 3 extensive benign lesions. All tumors were resected by a combined bi-frontal 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 wound infection, cerebrospinal fluid-leakage or meningitis. Recurrent tumor growth or systemic metastasis occurred in 3 out of 15 patients with malignant tumors, 6 months to 2 years postoperatively. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumors of anterior skull base.
Craniofacial Resection of Extensive Benign Lesions of the Anterior Skull Base
ANZ Journal of Surgery, 1987
The craniofacial resection operation was developed for the treatment of advanced nasal, paranasal and orbital malignancies. It has been refined in recent years, giving increased cure rates and better palliation when CUR is not possible. When used to mat extensive benign lesions involving the anterior skull base, this procedure allows more complete and safer resection with better access for repair and avoidance of major complications of brain damage, cerebrospinal fluid leak and haemorrhage. Resented here is a technique for craniofacial resection. The study demonstrates its effectiveness and low morbidity in treating 10 patients with extensive benign disease.
Closure of large skull base defects after endoscopic transnasal craniotomy
Journal of Neurosurgery, 2009
S UBSTANTIAL advances in SBS have been made in the past decade. There are endoscopic approaches to the entire ventral skull base, and the diversity of pathologies treated endoscopically has grown substantially. Along with managing cerebrovascular structures, the repair of a large skull base defect resulting from endoscopic transnasal craniotomy remains a difficult challenge. Problems with closure of the dura mater and prevention of CSF leaks are a persistent source of complications in both endoscopic and open SBS; these problems have even been described as the Achilles heel of endoscopic SBS. Small defects and CSF fistulas have an excellent rate of closure via an endoscopic technique. A > 90% closure rate with primary endoscopic surgery and a 97% closure rate with endoscopic revision are possible. 18 Most published reports on these techniques describe the use of free grafts. Defects in the skull base that result from resection of neoplasms and intracranial tumors and the repair of encephaloceles are much larger. Reported case series of endoscopic SBS, with extensive bone removal and subsequent intradural surgery, have generally described much higher rates of CSF leaks. 9,11,13,23,26 A variety of reconstructive techniques have been described. The use of multilayered free grafts was previously popular among surgeons with endoscopic skull base experience. Over the past decade, the use of vascularized mucosal pedicled flaps has been the most significant ad-Object. The authors describe the utility of and outcomes after endoscopic transnasal craniotomy and skull reconstruction in the management of skull base pathologies.