Transfacial approaches to the skull base: the early contributions of harvey cushing

The transbasal approach to the anterior skull base: surgical outcome of a single-centre case series

A variety of sinonasal tumours, meningiomas or other lesions of the anterior skull base involve the paranasal sinuses and the periorbital area. The transbasal approach (TBA) has turned out to be a feasible technique to reach those lesions. A retrospective review at a neurosurgical university department between November 2007 and January 2020 with adult patients who underwent resection of oncologic pathologies through TBA. Surgical technique, extent of resection (EOR), clinical outcome and postoperative complications were analysed. 18 TBAs between November 2007 and January 2020 were performed. Median age was 62 (range 25–83), 7 female and 11 male patients. Gross total resection rate was 85.8% throughout all entities. Four (22.2%) patients suffered from WHO°I meningiomas and 14 (77.7%) from other extra-axial lesions. Preoperative Karnofsky Performance Status Scale (KPSS) was 80% (range 40–90), postoperative KPSS 80% (range 20–100). Rate of postoperative complications requiring intervention was 16.7%. Median follow-up was 9.8 (range 1.2–71.8) months. Modifications and extensions of the classic TBA are not mandatory. Complete resection can be performed under functional and cosmetic-preserving aspects. Second-step procedures such as transnasal approaches may be performed to avoid high morbidity of more aggressive TBAs, if necessary. Surgical considerations should be kept simple and straightforward.

Role of craniofacial surgery in oral and maxillofacial tumors involving the skull base: A retrospective analysis of 126 patients

OBJECTIVES

Oral and maxillofacial tumors involving the skull base (SB) are rare and complex, making treatment difficult and controversial. The purpose of the present study was to evaluate the treatment efficacy of craniofacial surgery (CFS).

STUDY DESIGN

Patients who underwent CFS for these tumors between May 2000 and November 2017 were retrospectively analyzed. Clinicopathologic and treatment modality data were collected and follow-up was recorded. Kaplan-Meier and log-rank tests and Cox-regression model were used for survival analysis.

RESULTS

In total, 126 patients were enrolled (70 males and 56 females; 97 malignant tumors). Squamous cell carcinoma accounted for the majority of tumors. The lip-submandibular-neck approach was most frequently applied. Through-and-through SB bone or partial dura resection was performed in 42 cases. A pathologic positive margin was found in 18 cases. Of the included patients, 80 underwent simultaneous craniofacial reconstruction. The postoperative complications rate was 11.1%. Estimated 1-year, 3-year, and 5-year overall survival rates were 78.8%, 68.2%, and 54.4% respectively; and the 1-year, 3-year, and 5-year recurrence-free survival rates were 77.4%, 66.8%, and 63.8%, respectively. Multivariate analysis indicated postoperative complications, radiotherapy, recurrence, and metastasis status had a negative impact on survival (P < .05).

CONCLUSIONS

Although tumors involving the SB had various clinicopathologic characteristics, with interdisciplinary cooperation, CFS is an optimal option.

Combined Minimally Invasive Supraciliary and Transfacial Approach for Large Tumors with Skull Base and Sinonasal Involvement

BACKGROUND

Tumors invading both the anterior skull base and the sinonasal area have traditionally been accessed via largely invasive open craniofacial approaches. Minimally invasive extended endoscopic endonasal approaches have recently become increasingly available but have anatomical limitations and require incremental experience and thus high patient volume. Our objective was to assess the applicability of a novel combination of the minimally invasive supraciliary incision and the limited maxillofacial osteotomy as a combined surgical approach for large tumors invading both the anterior skull base and the sinonasal area.

METHODS

The well-established technique of supraciliary incision with a 2.5 × 3.0-cm craniotomy was combined for the first time with limited facial translocation approach.

RESULTS

This series involves 11 cases (female/male ratio 4:7; ranging in age from 6 to 61 years). Intracranial tumor propagation with intranasal and ethmoidal extension was detected in all patients. The pathologic diagnoses included adenocarcinomas, esthesioneuroblastoma, rhabdomyosarcoma, sinonasal papilloma, meningioma, and neurofibroma. The postoperative approach-related mortality rate was zero. No case of cerebrospinal fluid leak was detected. The 3-year survival rate was 70%.

CONCLUSIONS

The limited transfacial approach in combination with a supraciliary extension is associated with minimal mortality and morbidity and facilitates gross total tumor removal. We highly recommend this approach for the surgical treatment of large tumors invading both the anterior skull base and the sinonasal area, especially for those being out of indication for extended endoscopic endonasal surgery.