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

Abstract

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.

Quality of Life Following Endonasal Skull Base Surgery

“…Recent advances in the treatment of cranial base malignancies have had a major positive impact on the long-term survival of patients. 1,2 However, the treatments and reconstruction methods may be associated with significant inherent morbidities that may negatively affect a patient's physical function and emotional well-being. Consequently, a patient's QOL associated with various treatment modalities and reconstruction strategies assumes greater importance.…”

Estudio retrospectivo de 11 casos de estesioneuroblastomas tratados en el Hospital Santa Creu i Sant Pau entre los años 2000 y 2008 más revisión de la literatura

“…Los casos eran estadío B y C de Kadish, por lo que la elección del tipo de tratamiento está en sintonía con la mayoría de artículos publicados (mejores supervivencia en el grupo de cirugía más RT (65%), artículo de Dulguerov 18 ). En el caso que se utilizó la QMT previa a la cirugía porque la enfermedad estaba localmente muy avanzada, es una opción a considerar, siendo utilizada de esta manera por otros autores como Resto 51 (en 3 de sus 27 pacientes), Loy 37 (en los pacientes con grado C de Kadish utiliza QMT y RT preoperatoria) y Díaz 17 (en 5 de los 30 pacientes presentados, 4 eran estadío C), entre otros.…”

“…Sobre la controversia que existe sobre el diagnóstico diferencial entre ENB y carcinoma indiferenciado, varios artículos hablan sobre el error diagnóstico que se establece cuando se considera que es un ENB cuando en realidad es un carcinoma indiferenciado. Westra 51 , anatomopatóloga del hospital John Hopkins revisó los espécimenes histológicos de 37 pacientes y encontró que 8 (21,6%) estaban excluidos por no encontrarse los criterios de inclusión diagnósticos de ENB. Cohen 12 publica una serie de 12 casos diagnosticados inicialmente de ENB, que tras ser revisados sólo en 2 de ellos se consideró que presentaban los criterios diagnósticos de ENB.…”

Tailored Extended Bifrontal Craniotomy for Anterior Skull Base Tumors: Anatomic Description of a Modified Surgical Technique and Case Series

“…16,17 Meticulous closure and use of vascularized pericranial graft to exclude the frontal and sphenoethmoidal sinuses remain imperative steps to allow safe use of the surgical corridor presented. [18][19][20] In each case, the mucosa of the frontal sinus was removed across all areas and an antibioticsoaked gelfoam sponge placed in the cavity during the case. Dura was opened in a linear fashion along the inferior margin of the osteotomy, approximately 1 fingerbreadth above the orbit, then closed primarily followed by a coat of tisseal.…”