Combined Minimally Invasive Supraciliary and Transfacial Approach for Large Tumors with Skull Base and Sinonasal Involvement

P. Barzó, Zsolt Zador, Mihaly Bodosi, Zsolt Bella, Daniel Jambor, Bela Fulop, J. Czigner

Research output: Article

4 Citations (Scopus)

Abstract

Background Tumors invading both the anterior skull base and the sinonasal area have traditionally been accessed via largely invasive open craniofacial approaches. Minimally invasive extended endoscopic endonasal approaches have recently become increasingly available but have anatomical limitations and require incremental experience and thus high patient volume. Our objective was to assess the applicability of a novel combination of the minimally invasive supraciliary incision and the limited maxillofacial osteotomy as a combined surgical approach for large tumors invading both the anterior skull base and the sinonasal area. Methods The well-established technique of supraciliary incision with a 2.5 × 3.0-cm craniotomy was combined for the first time with limited facial translocation approach. Results This series involves 11 cases (female/male ratio 4:7; ranging in age from 6 to 61 years). Intracranial tumor propagation with intranasal and ethmoidal extension was detected in all patients. The pathologic diagnoses included adenocarcinomas, esthesioneuroblastoma, rhabdomyosarcoma, sinonasal papilloma, meningioma, and neurofibroma. The postoperative approach-related mortality rate was zero. No case of cerebrospinal fluid leak was detected. The 3-year survival rate was 70%. Conclusions The limited transfacial approach in combination with a supraciliary extension is associated with minimal mortality and morbidity and facilitates gross total tumor removal. We highly recommend this approach for the surgical treatment of large tumors invading both the anterior skull base and the sinonasal area, especially for those being out of indication for extended endoscopic endonasal surgery.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalWorld Neurosurgery
Volume109
DOIs
Publication statusPublished - jan. 1 2018

Fingerprint

Skull Base
Neoplasms
Olfactory Esthesioneuroblastoma
Neurofibroma
Rhabdomyosarcoma
Mortality
Craniotomy
Papilloma
Meningioma
Osteotomy
Adenocarcinoma
Survival Rate
Morbidity

Keywords

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology

    Cite this

    Combined Minimally Invasive Supraciliary and Transfacial Approach for Large Tumors with Skull Base and Sinonasal Involvement. / Barzó, P.; Zador, Zsolt; Bodosi, Mihaly; Bella, Zsolt; Jambor, Daniel; Fulop, Bela; Czigner, J.

    In: World Neurosurgery, Vol. 109, 01.01.2018, p. 1-9.

    Research output: Article

    Barzó, P. ; Zador, Zsolt ; Bodosi, Mihaly ; Bella, Zsolt ; Jambor, Daniel ; Fulop, Bela ; Czigner, J. / Combined Minimally Invasive Supraciliary and Transfacial Approach for Large Tumors with Skull Base and Sinonasal Involvement. In: World Neurosurgery. 2018 ; Vol. 109. pp. 1-9.
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    abstract = "Background Tumors invading both the anterior skull base and the sinonasal area have traditionally been accessed via largely invasive open craniofacial approaches. Minimally invasive extended endoscopic endonasal approaches have recently become increasingly available but have anatomical limitations and require incremental experience and thus high patient volume. Our objective was to assess the applicability of a novel combination of the minimally invasive supraciliary incision and the limited maxillofacial osteotomy as a combined surgical approach for large tumors invading both the anterior skull base and the sinonasal area. Methods The well-established technique of supraciliary incision with a 2.5 × 3.0-cm craniotomy was combined for the first time with limited facial translocation approach. Results This series involves 11 cases (female/male ratio 4:7; ranging in age from 6 to 61 years). Intracranial tumor propagation with intranasal and ethmoidal extension was detected in all patients. The pathologic diagnoses included adenocarcinomas, esthesioneuroblastoma, rhabdomyosarcoma, sinonasal papilloma, meningioma, and neurofibroma. The postoperative approach-related mortality rate was zero. No case of cerebrospinal fluid leak was detected. The 3-year survival rate was 70{\%}. Conclusions The limited transfacial approach in combination with a supraciliary extension is associated with minimal mortality and morbidity and facilitates gross total tumor removal. We highly recommend this approach for the surgical treatment of large tumors invading both the anterior skull base and the sinonasal area, especially for those being out of indication for extended endoscopic endonasal surgery.",
    keywords = "Craniofacial surgery, Eyebrow incision, Minimally invasive, Sinonasal tumors, Skull base tumors",
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    AU - Zador, Zsolt

    AU - Bodosi, Mihaly

    AU - Bella, Zsolt

    AU - Jambor, Daniel

    AU - Fulop, Bela

    AU - Czigner, J.

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    N2 - Background Tumors invading both the anterior skull base and the sinonasal area have traditionally been accessed via largely invasive open craniofacial approaches. Minimally invasive extended endoscopic endonasal approaches have recently become increasingly available but have anatomical limitations and require incremental experience and thus high patient volume. Our objective was to assess the applicability of a novel combination of the minimally invasive supraciliary incision and the limited maxillofacial osteotomy as a combined surgical approach for large tumors invading both the anterior skull base and the sinonasal area. Methods The well-established technique of supraciliary incision with a 2.5 × 3.0-cm craniotomy was combined for the first time with limited facial translocation approach. Results This series involves 11 cases (female/male ratio 4:7; ranging in age from 6 to 61 years). Intracranial tumor propagation with intranasal and ethmoidal extension was detected in all patients. The pathologic diagnoses included adenocarcinomas, esthesioneuroblastoma, rhabdomyosarcoma, sinonasal papilloma, meningioma, and neurofibroma. The postoperative approach-related mortality rate was zero. No case of cerebrospinal fluid leak was detected. The 3-year survival rate was 70%. Conclusions The limited transfacial approach in combination with a supraciliary extension is associated with minimal mortality and morbidity and facilitates gross total tumor removal. We highly recommend this approach for the surgical treatment of large tumors invading both the anterior skull base and the sinonasal area, especially for those being out of indication for extended endoscopic endonasal surgery.

    AB - Background Tumors invading both the anterior skull base and the sinonasal area have traditionally been accessed via largely invasive open craniofacial approaches. Minimally invasive extended endoscopic endonasal approaches have recently become increasingly available but have anatomical limitations and require incremental experience and thus high patient volume. Our objective was to assess the applicability of a novel combination of the minimally invasive supraciliary incision and the limited maxillofacial osteotomy as a combined surgical approach for large tumors invading both the anterior skull base and the sinonasal area. Methods The well-established technique of supraciliary incision with a 2.5 × 3.0-cm craniotomy was combined for the first time with limited facial translocation approach. Results This series involves 11 cases (female/male ratio 4:7; ranging in age from 6 to 61 years). Intracranial tumor propagation with intranasal and ethmoidal extension was detected in all patients. The pathologic diagnoses included adenocarcinomas, esthesioneuroblastoma, rhabdomyosarcoma, sinonasal papilloma, meningioma, and neurofibroma. The postoperative approach-related mortality rate was zero. No case of cerebrospinal fluid leak was detected. The 3-year survival rate was 70%. Conclusions The limited transfacial approach in combination with a supraciliary extension is associated with minimal mortality and morbidity and facilitates gross total tumor removal. We highly recommend this approach for the surgical treatment of large tumors invading both the anterior skull base and the sinonasal area, especially for those being out of indication for extended endoscopic endonasal surgery.

    KW - Craniofacial surgery

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    KW - Skull base tumors

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