Preservation of olfaction in anterior craniofacial approaches

Spetzler, Robert F.; Herman, James M.; Beals, Stephen P.; Joganic, Edward F.; Milligan, John

doi:10.3171/jns.1993.79.1.0048

Cited by 138 publications

(35 citation statements)

References 15 publications

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“…The complication of anosmia caused by bilateral olfactory denervation is a disadvantage of this approach, but a circumferential osteotomy around the cribriform plate can preserve olfactory function. 38 The lateral extension of this approach is limited by the optic nerves, cavernous sinuses, petrous apexes, abducent nerves, and hypoglossal canals. Combination with the lateral approach is necessary for tumors extending beyond these anatomical limits.…”

Section: Selection Of Approachesmentioning

confidence: 99%

Surgical approaches and strategies for skull base chordomas

Tamaki

Nagashima²,

Ehara³

et al. 2001

FOC

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Object The management of chordomas involving the skull base continues to present a number of treatment-related problems. Recently, both radical resection and charged-particle irradiation or stereotactic radiosurgery have reportedly been found effective for tumor control and for promoting a better quality of life in patients. In this article the authors analyzed the outcomes in 17 patients with skull base chordomas who were surgically treated at Kobe University Hospital between 1972 and 2000. Methods Preoperative radiological examinations included magnetic resonance imaging, computerized tomography, angiography, and balloon occlusion test of the internal carotid artery. Among the various surgical approaches used to remove the tumor were the frontoorbitozygomatic, transmaxillary, transcondylar, transsphenoidal, and the transbasal. Total removal was achieved in two (12%), near-total removal in three (18%), subtotal removal in nine (52%), and partial removal in three patients (18%). Since 1990, chordomas have been radically resected via various skull base approaches; the combined total or near-total removal rate has been 80% in this period. Radical removal of the tumors has not led to an increased risk. At the final follow-up review (mean 59.5 month), 75% of the patients were still alive, and 25% had died of chordoma recurrence. The overall recurrence-free survival rate was 82% at 3 years and 51% at 5 years. The 5-year recurrence-free survival rate in the five patients who underwent the operation during the past decade was 77% (mean follow up of 5.2 years). In two patients with recurrent tumors who underwent radiosurgery, no evidence of tumor regrowth was demonstrated at 3 years posttreatment. Conclusions The authors suggest that for the treatment of skull base chordomas radical resection is a key factor for longer survival and improved quality of life. Patients with sufficiently small tumors, which show a favorable configuration and location, can be suitable candidates for stereotactic radiosurgery.

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Section: Selection Of Approachesmentioning

confidence: 99%

Surgical approaches and strategies for skull base chordomas

Tamaki

Nagashima²,

Ehara³

et al. 2001

FOC

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“…Finally, with increasing focus on anatomic preservation of the both or at least 1 olfactory tract, contemporary series of bifrontal and craniofacial approaches have reported excellent preservation of olfaction. [21][22][23] In our series, 2 patients had preexisting olfactory deficits and 1 patient developed a new deficit postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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

Safaee

McDermott

Benet

et al. 2017

ONSURG

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BACKGROUND Open transcranial approaches to the anterior skull base remain an integral component of current skull base practice. Evolution of these and other techniques has resulted in revisions of standard, tried-and-true methods in attempts to improve patient outcomes and cosmesis, while still providing the best combination of surgical exposure and ergonomics. OBJECTIVE To describe a modified approach for midline tumors of the anterior skull base. METHODS We describe the anatomy and techniques of a modified extended bifrontal craniotomy for anterior skull base tumors. Case examples and a postoperative 3-dimensional computed tomographic reconstruction of the craniotomy are provided. RESULTS The technique has been employed with success in 3 tuberculum sellae meningiomas where the anterior limit of the tumor is several centimeters back from the inner table of the frontal bone. The mean distance from the tumor to inner table was 2.8 cm (range 1.3-3.8 cm). Mean tumor dimensions were 3.0 cm (transverse), 3.5 cm (anterior-posterior), and 2.2 cm (craniocaudal). Average operative time was 557 min. No cases had new T2/fluid-attenuated inversion recovery magnetic resonance imaging signal of the inferior frontal lobe to indicate retraction injury. CONCLUSION The tailored extended bifrontal craniotomy for anterior skull base tumors provides adequate access to the anterior cranial fossa and has replaced our standard extended bifrontal approach. Keeping the osteotomy cut lines outside of the orbit reduces orbital swelling and mechanical disruption of conjugate eye movements in the early postoperative period, while allowing for minimal frontal lobe retraction and providing sufficient surgical exposure along the anterior skull base.

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“…However, if the surgical goal is to preserve olfaction or to perform an olfactory preserving cribriform osteotomy, then the frontonasal cut in the 1-piece TBA should not disrupt the cribriform plate. 20 In this study, the vertical angle from the midline frontonasal suture to the foramen cecum at the frontoethomoidal suture ranged from 17.4° to 29.7°. Thus, we recommend angling the frontonasal osteotomy at least 30° superiorly to avoid entrance into the cribriform plate (Fig.…”

Section: Discussionmentioning

confidence: 99%

The 1-piece transbasal approach: operative technique and anatomical study

Effendi¹,

Rao²,

Momin³

et al. 2014

JNS

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Object The transbasal approach (TBA) is an anterior skull base approach, which provides access to the anterior skull base, sellar-suprasellar region, and clivus. The TBA typically involves a bifrontal craniotomy with orbital bar and/or nasal bone osteotomies performed in 2 separate steps. The authors explored the feasibility of routinely performing this approach in 1 piece with a quantitative cadaveric anatomical study, and present an operative case example of their approach. Methods Seven latex-injected cadaveric heads underwent a 1-piece TBA, followed by additional bone removal typical for a traditional 2-piece approach. Six surgical angles relative to the pituitary stalk, as well as the surface area of the orbital roof osteotomy, were measured before and after additional bone removal. The vertical angle from the frontonasal suture to the foramen cecum was measured in all specimens. In addition to an anatomical study, the authors have used this technique in the operating room, and present an illustrative case of resection of an anterior skull base meningioma. Results Morphometric results were as follows: the vertical angle from the frontonasal suture to the foramen cecum ranged from 17.4° to 29.7° (mean 23.8° ± 4.8°) superiorly. Of the 6 surgical angle measures, only the middle horizontal angle was increased in the 2-piece versus the 1-piece approach (mean 43.4° ± 4.6° vs 43.0° ± 4.3°, respectively; p = 0.049), with a mean increase of 0.4°. The surface area of the orbital osteotomy was increased in the 2-piece versus the 1-piece approach (mean 2467 mm2 ± 360 mm2 vs 2045 mm2 ± 352 mm2, respectively; p < 0.001). The patient in the illustrative clinical case had a good outcome, both clinically and cosmetically. Conclusions The 1-piece TBA provides an alternative to the traditional 2-piece approach. It allows easier reconstruction, potentially decreased operative time, and improved cosmesis. While more of the orbital roof can be removed with the 2-piece approach, this additional bone removal offers only a small increase in 1 of 6 surgical angles that were measured.

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Preservation of olfaction in anterior craniofacial approaches

Cited by 138 publications

References 15 publications

Surgical approaches and strategies for skull base chordomas

Surgical approaches and strategies for skull base chordomas

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

The 1-piece transbasal approach: operative technique and anatomical study

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