Transglabellar Subcranial Approach for the Management of Nasal Masses With Intracranial Extension in Pediatric Patients

Goyal, Parul; Kellman, Robert M.; Tatum, Sherard A.

doi:10.1001/archfaci.9.5.314

Cited by 14 publications

(6 citation statements)

References 16 publications

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“…This can be performed through an endonasal, endoscopic approach or via a craniotomy. 19,20 Surgical approaches to anterior skull base encephaloceles have evolved in the recent decades. Endoscopic endonasal surgery has become more widely adopted as a viable approach.…”

Section: Meningoencephalocelementioning

confidence: 99%

Complications of Skull Base Surgery

Sokoya

Mourad

Ducic

2017

Seminars in Plastic Surgery

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Approaches to surgical management of skull base pathology and reconstruction of skull base defects have evolved over the past several decades. Surgical management of this area requires complex surgical planning and execution and is associated with a myriad of potential complications. The goal, however, remains the same-to effectively address the pathology with minimal complications.Walter Dandy initially described a combined craniofacial approach to an orbital tumor in 1942.1 Ray and McLean utilized this approach for the surgical management of retinoblastoma 2 years later. 2 In 1954, Smith et al reported the application of the craniofacial approach for resection of sinonasal tumors. Ketcham et al also reported a series of 89 patients with malignant skull base tumors resected through a craniofacial approach. This approach was associated with a low mortality rate of 3%. 3,4Later in the 20th century, endoscopy became to be more widely used in surgery. Endoscopy-assisted skull base surgery became the mainstay of surgical management of sinonasal and skull base tumors. Yuen et al reported a series of patients, with olfactory neuroblastoma, treated with endoscopy-assisted craniofacial resection, with minimal complications.5 Stammberger was one of the pioneers of complete transnasal endoscopic resection of anterior skull base tumors. 6Comparisons of craniofacial resection (CFR) and transnasal endoscopic resection (TER) have been performed by multiple groups. Most notably, Batra et al compared 16 patients who underwent CFR with 9 patients who underwent TER. Patients who underwent TER had shorter operative times, shorter intensive care unit stay, lower rates of major complications, and decreased mortality. 7Endoscopic approaches are applied not only to sinonasal and skull base malignancies but also to other disorders, such as encephaloceles, cerebrospinal fluid (CSF) leaks, mucoceles, and pituitary neoplasms. Advantages of endoscopic approaches include better visualization of the clivus and parasellar regions. These approaches also allow the surgeon to avoid manipulating intracranial structures such as the frontal lobe.Effective management of skull base pathology requires involvement of a multidisciplinary team. This team of otolaryngologists, neurosurgeons, plastic surgeons, ophthalmologists, radiation oncologists, medical oncologists, anesthesiologists, and rehabilitation specialists is vital to ensure optimal surgical results. This multidisciplinary approach is essential to decreasing complications and mortality.Commonly reported complications of skull base surgery include meningitis, CSF leak, visual changes, cerebral infarct, subdural hemorrhage, epidural abscess, hydrocephalus, chronic rhinosinusitis, sinonasal mucocele, hematoma, epistaxis, and death. The likelihood of these complications is largely dependent on the nature of pathology that is being treated, whether it be malignant diseases, such as esthesioneuroblastoma, or benign pathologies, such as a pituitary macroadenoma. Understanding of the possibility of t...

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Section: Meningoencephalocelementioning

confidence: 99%

Complications of Skull Base Surgery

Sokoya

Mourad

Ducic

2017

Seminars in Plastic Surgery

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“…[252627] Other disadvantages include more chances of brain parenchymal injuries as it involves frontal lobe retraction, large external scar, and more chances of cerebrospinal fluid (CSF) leak. [27]…”

Section: Discussionmentioning

confidence: 99%

“…[25] The greatest disadvantage of this approach is that it requires to be combined with other transfacial or endoscopic approaches for successful resection of large tumor mass with nose and paranasal sinus involvement. [25][26][27] Other disadvantages include more chances of brain parenchymal injuries as it involves frontal lobe retraction, large external scar, and more chances of cerebrospinal fluid (CSF) leak. [27] The subcranial approach is an effective technique for the resection of nasal masses with intracranial extension.…”

Section: Discussionmentioning

confidence: 99%

Sinonasal teratocarcinosarcoma involving nasal cavity, nasopharynx, and all paranasal sinuses with bilateral orbital and intracranial extension: A rare case report

et al. 2017

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Sinonasal teratocarcinosarcoma (SNTCS) is one of the rarest, aggressive malignant neoplasms of sinonasal tract, consisting of primitive neuroepithelial elements with various malignant epithelial and mesenchymal components. Previously described as teratoid carcinosarcoma, malignant teratoma, or blastoma, SNTCS constitutes less than 1% of all cancers and approximately 3% of all malignancies of head and neck region, which is mainly located in the nasal cavity and paranasal sinuses, although tumors occurring in other locations including the nasopharynx and oral cavity have been described. Here, we are presenting a 22-year-old patient with SNTCS involving the nasal cavity, nasopharynx, and all paranasal sinuses with bilateral orbital and intracranial extension treated with surgery followed by radiotherapy and chemotherapy.

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“…Kellman et al 6 in 2004 published their results of this approach in three patients with uncomplicated nasal dermoid cysts. In 2007, this group published another communication 7 and concluded that the technique is effective in younger patients, provides excellent exposure, minimizes frontal lobe retraction and cerebrospinal fluid fistulas, and has excellent cosmetic results. Follow-up of these patients showed that their facial growth was not impaired.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 In the medical literature, there are few publications on this approach in pediatric patients. [6][7][8] From January 1996 to October 2008 in the Plastic and Reconstructive Surgery Unit at a Children Hospital of Buenos Aires, we used the subcranial approach in a limited number of pediatric patients with nontraumatic pathology. The purpose of this article is to communicate this experience.…”

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confidence: 99%

Subcranial Approach in Pediatric Craniofacial Surgery

Ciechomski

Aufgang

Villanueva

et al. 2010

Craniomaxillofacial Trauma & Reconstruction

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We report our experience with the subcranial approach, developed at the Plastic Surgery Unit of Hospital ''Ricardo Gutiérrez,'' for the treatment of injuries in the frontoethmoidal orbital region in pediatric patients. The subcranial approach was described by Raveh et al for the treatment of fractures in the frontoethmoidal area. The subcranial approach was used later for surgery of tumors and deformities of the frontoethmoidal region. We have used this approach in nine cases of nontraumatic injuries (one meningioma, one orbital bone fibrous dysplasia, one vascular malformation, five nasal dermoid cysts, and one fronto-orbital mucocele). One patient with vascular malformation died of a stroke 10 days after surgery. The patient with the meningioma had a recurrence. Another patient developed an infection that needed surgical resolution and hardware removal. A third patient suffered a mild infection that receded with medication. No other complications were registered. The surgical exposure obtained through this approach was always excellent and left no cosmetic defects. There was no evidence of facial growth disturbance in this group of patients, except in one patient who received radiotherapy after surgery. Operative time and hospitalization were lower in this group than in patients with conventional frontal craniotomy.

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Transglabellar Subcranial Approach for the Management of Nasal Masses With Intracranial Extension in Pediatric Patients

Cited by 14 publications

References 16 publications

Complications of Skull Base Surgery

Complications of Skull Base Surgery

Sinonasal teratocarcinosarcoma involving nasal cavity, nasopharynx, and all paranasal sinuses with bilateral orbital and intracranial extension: A rare case report

Subcranial Approach in Pediatric Craniofacial Surgery

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