A combined intracranial facial approach to the paranasal sinuses

Ketcham, Alfred S.; Wilkins, Robert H.; Buren, J. M. Van; Smith, Robert R.

doi:10.1016/0002-9610(63)90387-8

Cited by 476 publications

(191 citation statements)

References 12 publications

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“…17,18 This technique requires a frontal craniotomy along with a transfacial approach to allow broad exposure of the anterior cranial fossa and subcranial compartment. The use of CFR and other surgical approaches to the anterior skull base (ie, the subcranial approach) has been documented for a variety of malignant and benign tumors.…”

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confidence: 99%

Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study

Gil

Patel

Singh

et al. 2007

Cancer

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BACKGROUND. Single‐institutional studies lack sufficient power to assess the role of surgery and radiotherapy in the management of sarcomas involving the anterior skull base. For this study, an international collaborative study group analyzed a large cohort of patients who underwent surgery for the treatment of skull base tumors. METHODS. A subset of 146 patients who had a histologic diagnosis of skull base sarcoma (SBS) formed the basis of this report. Most patients were aged ≥21 years (77%) and had stage IV disease (56%). Adjuvant radiotherapy was received by 35% of patients, and chemotherapy was received by 10% of patients. RESULTS. Orbital involvement was encountered in 53% of patients, involvement of the orbital wall was encountered in 46% of patients, and intracranial extension was encountered in 28% of patients. Positive microscopic margins were reported in 43% of patients (51 of 118 patients). Treatment‐related complications were reported in 27% of patients, and postoperative mortality was reported in 1.4% of patients. With a median follow‐up of 34 months, the 5‐year overall, disease‐specific, and recurrence‐free survival rates were 62%, 64%, and 57%, respectively. Tumor grade and adjuvant radiotherapy were not significant predictors of survival. Prior radiotherapy, intraorbital extension, positive margins, and postoperative complications were significant predictors of reduced disease‐specific survival on univariate analysis. The presence of positive/close margins, however, was the only independent predictor of poor overall, recurrence‐free, and disease‐specific survival on multivariate analysis (relative risk, 2.4; P = .006). The 5‐year disease‐specific survival rate was 77%, 43%, and 36% for patients with negative, close, and positive margins, respectively. CONCLUSIONS. The current results indicated that wide craniofacial resection with negative margins is an independent prognostic predictor of better outcome. Patients with positive margins have a high risk for tumor recurrence independent of tumor grade. Cancer 2007. © 2007 American Cancer Society.

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confidence: 99%

Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study

Gil

Patel

Singh

et al. 2007

Cancer

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“…All patients were operated upon utilizing the standard transcranial/transfacial approach described elsewhere. [1][2][3] A team utilizing the coordinated efforts of a neurosurgeon and an otolaryngologist resected the tumor attempting to achieve tumor-free margins in all cases. In those patients who had not been previously irradiated, whenever possible a full course of radiation therapy was given 4 to 6 weeks following surgery.…”

Section: Methodsmentioning

confidence: 99%

Sinonasal Undifferentiated Carcinoma with Intracranial Extension

Donald

2006

Skull Base

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Aim: To report our experience in the management of sinonasal undifferentiated carcinoma (SNUC) over a period of 15 years. Study design: A retrospective case review of 13 patients with SNUC treated at the University of California, Davis, Medical Center (UCDMC) Center for Skull Base Surgery, over the past 15 years. Results: Most tumors arose in the ethmoid sinuses. All but 1 patient had a combined intracranial-extracranial resection through the anterior fossa-transcranial route and postoperative irradiation. The 13th patient had a transfacial subcranial approach. There are 6 who have survived free of disease at 14 years' to 8 months' follow-up. The average follow-up was 6 years, 3 months. One patient died of a pulmonary embolism in the first postoperative week, a second died of a bowel infarction 3 months postoperatively. Three patients died of their disease at 20, 18, and 8 months postoperatively: 1 with local recurrence and distant metastasis and the other 2 with local control but distant disease. The 6 survivors are at 8, 20, 28, 62, 84, and 105 months. Conclusion: SNUC is a rare malignancy of the paranasal sinuses with a poor prognosis. Radical surgery and adjunctive therapy can achieve good survival in a significant proportion of patients who would hitherto have seemed incurable. KEYWORDS: Sinonasal undifferentiated carcinoma, malignancy, skull base surgerySinonasal undifferentiated carcinoma (SNUC) is an aggressive malignancy originating in the mucosa lining the walls of the nasal cavity and paranasal sinuses. It is a rare tumor that usually presents in an advanced stage, is highly invasive, and is traditionally reputed to be refractory to even the most radical therapy with an attendant poor prognosis. This is particularly true when it transgresses the cranial base. We present a personal series of 13 consecutive cases of SNUC with transgression of the skull base seen at the University of California Center for Skull Base Surgery, all of which were treated with curative intent by skull base surgery.

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“…Se cimenta en estudios pioneros de Frazier, Smith y Ketcham 15 quienes demuestran las posibilidades de los abordajes transfaciales y tras los avances obtenidos por Tessier y Derome 7 en relación al abordaje transbasal. Fue posteriormente utilizado para la corrección de malformaciones craneofaciales congénitas y en 1980 se describe por primera vez su uso en cirugía oncológica basicraneal 24 .…”

Section: Tabla III Complicaciones Pstquirúrgicasunclassified

Abordaje subcraneal: Consideraciones técnicas y aplicaciones en patología traumática craneofacial

et al. 2010

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ResumenIntroducción. La elección del abordaje más adecuado a la base craneal en cada caso es esencial para la obtención de resultados quirúrgicos globales satisfactorios. Inicialmente dependerá de la localización anató-mica exacta de la lesión dentro de la base craneal y de su extensión tridimensional, así como de la naturaleza de la misma. Las opciones posibles deben ser depuradas finalmente en función del status global del paciente, planificación reconstructiva y experiencia del equipo quirúrgico. El abordaje subcraneal es una opción terapéutica segura en el tratamiento de la patología traumática frontal. Permite el manejo adecuado del seno frontal y su obliteración si es precisa, favoreciendo el seguimiento radiológico del mismo.Objetivos presentaban patología oncológica. Se enumeran los casos oncológicos como base de experiencia para la descripción de los aspectos técnicos. La casuística descrita se refiere a la patología traumática y sus secuelas. Los principales parámetros analizados fueron la técnica quirúrgica incluyendo el material de relleno para la obliteración del seno frontal, patología traumática asociada, estancia hospitalaria y tasa de complicaciones.Resultados. No existió mortalidad intra-postoperatoria inmediata. La edad varía entre los 15-76 años siendo 22 varones y 12 mujeres. Se describe el tipo de fracturas frontales asociadas. El material de relleno empleado en la obliteración frontal fue hueso de calota. El 29% de los pacientes con patología traumática o secuelas presentaron morbilidad precoz-tardía. La estancia media hospitalaria fue de 13 días.Conclusiones. El abordaje subcraneal a la base craneal anterior es una técnica versátil y razonable en el tratamiento quirúrgico de la patología de dicha región anatómica. Aporta una exposición excelente de la cavidad nasal, órbitas y celdillas etmoidales-seno esfenoidal, permitiendo un amplio acceso a la fosa anterior con mínima retracción de los lóbulos frontales. Conclusions. Subcranial approach to anterior cranial base is a safe and reliable treatment option to the pathology of this area. It allows outstanding exposure of the nasal cavity, orbits, ethmoidal cells-sphenoid sinus and great access to anterior fossa without frontal lobe retraction. PALABRAS CLAVE

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A combined intracranial facial approach to the paranasal sinuses

Cited by 476 publications

References 12 publications

Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study

Analysis of prognostic factors in 146 patients with anterior skull base sarcoma: An international collaborative study

Sinonasal Undifferentiated Carcinoma with Intracranial Extension

Abordaje subcraneal: Consideraciones técnicas y aplicaciones en patología traumática craneofacial

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