The Subcranial Approach for Fronto-Orbital and Anteroposterior Skull-Base Tumors

Raveh, Joram; Laedrach, Kurt; Speiser, Mortimer D.; Chen, J.; Vuillemin, Thierry; Seiler, Rolf W.; Ebeling, U.

doi:10.1001/archotol.1993.01880160029006

Cited by 156 publications

(108 citation statements)

References 20 publications

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“…Bifrontal craniotomies and unilateral subfrontal approaches, as well as pterional approaches, have been successfully employed and become standard approaches for olfactory groove meningiomas. 10,51,56 Meningiomas extending into the paranasal sinuses have been accessed using more aggressive techniques, such as the transbasal, subcranial, 12,46 and fronto-orbital approaches. Furthermore, combined approaches have been attempted as well, such as frontal or bifrontal craniotomies in conjunction with orbital or nasal osteotomies, and craniofacial resection.…”

Section: Discussionmentioning

confidence: 99%

Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches

Banu

Mehta

Ottenhausen

et al. 2016

JNS

102

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O lfactOry groove meningiomas arise from the midline anterior cranial fossa, extend from the crista galli to the planum sphenoidale, and account for 8% to 13% of meningiomas. 2,41 Frequently, these massive tumors can extend posteriorly and envelop the anterior clinoid processes and the parasellar region. Moreover, these aggressive meningiomas can infiltrate and erode the cribriform plate, invading the ethmoid and sphenoid sinus. Microsurgical approaches include bicoronal, pterional, and lateral supraorbital "keyhole" craniotomies. 2,42 In the abbreviatioNs DVT = deep venous thrombosis; EOR = extent of resection; GTR = gross-total resection; LMS = lion's mane sign; NTR = near-total resection; STR = subtotal resection. obJective Although the endonasal endoscopic approach has been applied to remove olfactory groove meningiomas, controversy exists regarding the efficacy and safety of this approach compared with more traditional transcranial approaches. The endonasal endoscopic approach was compared with the supraorbital (eyebrow) keyhole technique, as well as a combined "above-and-below" approach, to evaluate the relative merits of each approach in different situations. methods Nineteen cases were reviewed and divided according to operative technique into 3 different groups: purely endonasal (6 cases); supraorbital eyebrow (microscopic with endoscopic assistance; 7 cases); and combined endonasal endoscopic with either the bicoronal or eyebrow microscopic approach (6 cases). Resection was judged on postoperative MRI using volumetric analysis. Tumors were assessed based on the Mohr radiological classification and the presence of the lion's mane sign. results The mean age at surgery was 61.4 years. The mean tumor volume was 19.6 cm 3 in the endonasal group, 33.5 cm 3 in the supraorbital group, and 37.8 cm 3 in the combined group. Significant frontal lobe edema was identified in 10 cases (52.6%). The majority of tumors were either Mohr Grade II (moderate) (42.1%) or Grade III (large) (47.4%). Gross-total resection was achieved in 50% of the endonasal cases, 100% of the supraorbital eyebrow cases with endoscopic assistance, and 66.7% of the combined cases. The extent of resection was 87.8% for the endonasal cases, 100% for the supraorbital eyebrow cases, and 98.9% for the combined cases. Postoperative anosmia occurred in 100% of the endonasal and combined cases and only 57.1% of the supraorbital eyebrow cases. Excluding anosmia, permanent complications occurred in 83.3% of the cases in the endoscopic group, 0% of the cases in the supraorbital eyebrow group, and 16.7% of cases in the combined group (p = 0.017). There were 3 tumor recurrences: 2 in the endonasal group and 1 in the combined group. coNclusioNs The supraorbital eyebrow approach, with endoscopic assistance, leads to a higher extent of resection and lower rate of complications than the purely endonasal endoscopic approach. The endonasal endoscopic approach by itself may be suitable for a small percentage of cases. The combined above-and-below approaches are use...

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Section: Discussionmentioning

confidence: 99%

Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches

Banu

Mehta

Ottenhausen

et al. 2016

JNS

102

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“…The subcranial approach has been described in detail elsewhere. 18 Briefly, after incising the skin above the hairline, we create a bicoronal flap in a supraperiosteal plane. A flap is elevated anteriorly beyond the supraorbital ridges and laterally superficial to the fascia of the temporalis.…”

Section: Surgical Techniquementioning

confidence: 99%

Orbital tumors treated using transcranial approaches: surgical technique and neuroophthalmogical results in 41 patients

Margalit¹,

Ezer²,

Fliss³

et al. 2007

FOC

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Object Orbital tumors can be divided schematically into primary lesions, originating from the orbit itself, and secondary lesions, extending to the orbit from neighboring structures. These tumors are variable in their biological nature and in their location. The authors evaluate 41 cases of benign and malignant tumors involving the orbit and discuss the surgical challenge, which involves tumor removal, preserving visual function and cosmetic reconstruction. Methods The authors performed a retrospective analysis of a series of all cases involving patients who underwent surgery for treatment of orbital tumors in their hospital between December 2003 and December 2006. Data were collected from the patients' files in the hospital's outpatient clinic, operative notes, and pre- and postoperative imaging studies. Results The authors identified 41 patients who met the inclusion criteria (age range 14–82 years, mean 42.2 years, standard deviation 22.4 years). The most common presenting symptoms were proptosis and/or partial ptosis (11 cases [27%]) and headache (7 cases [17%]). In 5 (12%) cases, the tumors were primary intraorbital lesions, and in 34 cases (83%) they were secondary. Two patients had metastases to the orbit. The most common lesion types were meningioma (10 cases [24%]) and osteoma (7 cases [17%]). In 24 cases a midline approach through a frontal craniotomy or a subcranial approach was used; in 13 a lateral approach was used; and in 4 a biopsy procedure was performed. Maxillectomy through a Weber–Ferguson approach or a facial degloving approach was added in 5 cases to complete tumor removal. Duration of follow-up was 1–38 months (mean 20 months). None of the patients died as a result of the procedure, and there were relatively few complications. Excluding the patients who underwent orbital exenteration, none of the patients had visual deterioration following surgery, and most had no change in their visual condition. Two patients had temporary diplopia, 1 had a cerebrospinal fluid leak, and 1 had enophthalmos following removal of an orbital osteosarcoma. Conclusions Orbital tumors can be treated safely using transcranial approaches in many cases. Preoperative imaging can accurately define the compartments involved and the surgical approach needed for tumor removal. A multidisciplinary team of surgeons facilitates optimal tumor removal and skull base sealing as well as good cosmetic results.

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“…It eliminates facial incisions and thus immediate postoperative edema and further facial deformities and also lead to decreased complication rates of Csf leak and infection. 11 This approach has been described in the literature as giving a bicoronal incision and elevation of subperiosteal flap preserving the pericranium. The flap is then dissected down to the frontozygomatic sutures bilaterally, and to the rhinion and piriform apertures in the midline.…”

Section: Discussionmentioning

confidence: 99%

Extramedullary plasmacytoma nose operated by raveh’s approach: a case report

et al. 2017

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Plasmacytoma is a clonal proliferation of plasma cells. Plasmacytoma can be disseminated in the form of multiple myeloma or solitary disease. Most common site of involvement of solitary extramedullary plasmacytoma being the upper respiratory tract. We present a case report of 60-year-old male who presented with bilateral nasal obstruction, epistaxis and swelling on the root of nose. Biopsy proved out to be a plasmacytoma which was operated by Raveh’s approach. Raveh’s approach is a very useful approach for skull base tumors in the sphenoethmoidal plane with minimal morbidity, no frontal lobe retraction and watertight closure of dura and excellent postoperative recovery.

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The Subcranial Approach for Fronto-Orbital and Anteroposterior Skull-Base Tumors

Cited by 156 publications

References 20 publications

Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches

Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches

Orbital tumors treated using transcranial approaches: surgical technique and neuroophthalmogical results in 41 patients

Extramedullary plasmacytoma nose operated by raveh’s approach: a case report

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