Modified Approach for Ethmoid and Anterior Skull Base Surgery

Prognostic factors in sinonasal tumors involving the anterior skull base

“…The size of the frontal bone and the amount of the orbital rims included in the flap are determined by the amount of exposure that will be needed. 8 The use of a subcranial approach is essential in tumors involving both sides of the ethmoid, particularly if there is progression into the orbits, and provides wide access to the anterior fossa with minimal frontal lobe retraction.…”

“…Tumors with bilateral invasion of the ethmoid and extension or not to the orbits were managed with a subcranial approach. When, in addition to the bilateral involvement of the ethmoid, there was an important intracranial extension, the subcranial approach was enlarged, tailoring a wider osteoplastic flap as described by Pinsolle et al 8 All the tumors were large, and most of them disrupted at least the roof of the ethmoid. In 67 patients, other areas were involved, such the orbital periosteum, the sphenoid sinus, the optic nerve and anterior clinoid process, and the anterior part of the middle cranial fossa.…”

Modified transcranial approach for resection of tumors involving the anterior cranial fossa

“…But some disadvantages inherent to the combined procedure, such as great cosmetic concern, too much complexity of the procedures etc, make it necessary to deplore some less traumatic and less complex approach. Recently, we developed the so called cosmetic modified trnscranial approach for treating such kind of tumors, of which the key points, as described above are (1) one scalp incision is made instead of two; (2) in addition to the conventional frontal bony flap, a free orbito-naso-ethmoid bone flap is further taken out. This modified approach has the advantages of avoiding cosmetic concern over the humiliating facial scar, providing short distances to skull base, reducing the risk of dural laceration and neighboring structure damage, allowing minimal retractation of the frontal lobe, creating extensive surgical exposure, and achieving careful hemostasis.…”

“…Neither transcranial nor transfacial approach alone can allow enbloc resection of the involved paranasal sinuses in continuity with the cribriform plate area of the anterior skull base. Since the introduction of craniofacial resection in 1953, a number of reports [1][2][3] have claimed that the preferred approach for resection of the invasive tumors of the paranasal sinuses should be a combined craniofacial one. Being deeply situated, anterior skull base region contains many complex and functionally important neurovascular structures.…”

Surgical treatment of anterior skull base tumours

“…Soon it was realised that osteotomy of the fronto-naso-orbital external skeletal frame provides optimum anterior access to the orbital and spheno-ethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and facial incisions [1,2,17,28,33,36,38,42,49,52,58,78].…”