Anterior craniofacial resection - for paranasal sinus tumors involving anterior skull base (original) (raw)
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Otorhinolaryngology Clinics - An International Journal, 2011
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.
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.
Management of Malignant Tumors of the Anterior Skull Base and Paranasal Sinuses
Current Otorhinolaryngology Reports, 2016
In 1941 Dandy described anterior craniofacial resection of orbital tumors. 20 Prior to this, Frazier 27 championed removing orbital rims to gain improved surgical access. In 1943 Ray and McLean 59 combined a transcranial and transfacial approach for resection of a retinoblastoma. The first en bloc resection of an extensive paranasal sinus malignancy was initially reported by Smith, et al., 71 in 1954 and subsequently by Ketcham, et al., 38 and Van Buren, et al. 79 Although complete tumor resection had considerable benefits, the toll was an 80% morbidity rate and a 7% mortality rate. 38,69 The major cause of morbidity was intracranial contamination due to sinonasal tract communication. 64 This complication was reduced when reconstructive techniques involving pericranial grafts were introduced in 1979 by Schramm, et al., 65 and modified later by Johns, et al. 37 With improvements in surgical techniques, the morbidity rate decreased to less than 40% and mortality to between 0 to 2%. 45,46 In 1960 Tessier, et al., 76 pioneered the transbasal approach for the reduction of craniofacial abnormalities. Derome, alone, 21 with Tessier, 22 and with others 23 used this approach for sphenoethmoidal tumor removal beginning in the 1970s. Modifications of this approach have led to increased anterior cranial fossa exposure requiring minimal brain retraction. Anterior transfacial approaches were described as early as 1829 by Lizars. Modifications were described by Fergusson in 1842. 9 In the 1920s, Portmann and Retrouvey reported the midfacial degloving procedure. 7 Casson and associates 10 further modified this technique, which was then popularized by Conley and Price 16 and Price alone. 55 A subcranial approach obviating the need for the transfacial approach was initially described by Raveh, et al., 58 in 1978 for the management of craniofacial fractures and subsequently performed for the management of anterior skull base tumors. The management of malignant tumors of the anterior skull base can be technically demanding and has been associated with high rates of morbidity and mortality. Advances in neuroimaging leading to earlier diagnosis, a better understanding of the anatomy, and collaboration among experienced surgeons has led to significant progress in the management of these lesions. MANAGEMENT OF ANTERIOR SKULL BASE MALIGANCIES Presentation and Neuroimaging Features Anterior fossa tumors can manifest as a number of different symptoms, including nasal obstruction and congestion, epistaxis, rhinorrhea, hyposmia or anosmia, headache, seizure, and psychological changes. Paresthesias in the distribution of the V1 or V2 divisions of the trigeminal nerve may occur. Invasion into the sella turcica can cause loss of endocrine function, or invasive pituitary tu-Neurosurg Focus 13 (4):Article 5, 2002, Click here to return to Table of Contents
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2005
Background. Malignant tumors of the superior sinonasal vault are rare, and, because of this and the varied histologic findings, most outcomes data reflect the experience of small patient cohorts. This International Collaborative study examines a large cohort of patients accumulated from multiple institutions experienced in craniofacial surgery, with the aim of reporting benchmark figures for outcomes and identifying patient-related and tumor-related predictors of prognosis after craniofacial resection (CFR).
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 in the management of paranasal sinus cancer
Journal of Clinical Neuroscience, 1994
The prognosis for patients with cancer of the paranasal sinuses (PNC) has been very poor, mainly due to a high rate of local recurrence. We report a series of 46 patients with PNC treated by craniofacial resection at the Royal Melbourne Hospital between November 1983 and June 1991. There has been no operative mortality or serious morbidity in these patients. The importance of a pericranial flap in the reconstruction of the floor of the anterior cranial fossa is emphasized. All patients have been followed to death or to the present time. There was a five year survival of 73% for squamous cell carcinoma and 83% for adenocarcinoma. This appears to represent a significant improvement in the long term results over conventional surgery and radiotherapy. The strong association between adenocarcinoma of the ethmoid sinuses and occupational exposure to hardwood dusts is borne out in our series. A history of prolonged wood dust exposure was given by all the 16 patients with adenocarcinoma and by 12 of the 25 patients with squamous cell carcinoma.
Role of skull base surgery for local control of sarcomas of the nasal cavity and paranasal sinuses
Oto-Rhino-Laryngology, 1994
Sarcomas of the nose and paranasal sinuses are rare neoplasms and comprise less than 1% of the malignancies arising in the sinonasal tract. From 1977 to 1989, we had the opportunity to treat 15 patients presenting with these tumors at The Eye & Ear Institute of the University of Pittsburgh. The clinical charts of these patients were reviewed retrospectively for demographic data, characteristics of disease, treatment considerations and clinical outcome. Data were also analyzed with special attention to the role of skull base surgery for the local control of tumors. Seven patients underwent cranial base surgery as part of their original therapy. Two of these patients are alive with no evidence of disease, one patient died of other causes, and four are dead of disease. Two patients died with local disease. Although not statistically significant due to the small number of patients, these data suggest that cranial base surgery can improve the local control of sarcomas of the sinonasal tract that approach or invade the skull base.
Otolaryngologic clinics of North America, 2017
Malignancies of the paranasal sinuses and ventral skull base present unique challenges to physicians. A transfacial or craniofacial approach allows for wide, possibly en bloc, resection and is ideal for tumors that involve surrounding soft tissue, the palate, the orbit, anterolateral frontal sinus, and lateral dura. Transfacial approaches include a lateral rhinotomy often combined with a medial, subtotal, or total maxillectomy. Reconstruction is most commonly performed with a pericranial flap to separate the intranasal and intracranial compartments. These approaches have evolved and been refined but now are usually reserved for advanced tumors not amenable to endoscopic resection.
Combined Nasal Endoscopic and Subfrontal Craniotomy for Resection Tumors of Anterior Skull Base
Objective: Sinonasal tumors invading anterior skull base is difficult to treat in Otorhinolaryngology and Neurosurgery. Treatment requires the collaboration of ear, nose and throat (ENT) and neurosurgeon to remove the tumor completely. This study was to evaluate the outcome of combined technique nasal endoscopic and subfrontal approach in case of sinonasal tumors involving anterior skull base Methods: Retrospective cross-sectional study Results: The study was a cross-sectional study that had taken place at Otorhinolaryngology and Neurosurgery Department of Cho Ray Hospital, Vietnam. All 45 patients were enrolled and underwent the surgery. 71.1% of these cases were malignant tumors. The ratio of sinonasal malignant tumor is squamous cell carcinoma and esthesioneuroblastoma were 24.4% and 11.1%, respectively. All the cases were diagnosed as sinonasal tumor invading anterior skull base and successfully removed by combining nasal endoscopic approach with subfrontal craniotomy. Conclusions: The combined nasal endoscopic with subfrontal craniotomy for resection nasoethmoid tumor invading the brain show a good result. This technique is an important adjunct that contribute to the treatment of anterior skull base tumor involving the brain.