Operative results in fourteen cases of paranasal sinus and anterior cranial fossa lesions surgically treated by an extended transbasal approach
Kumon, Y.; Zenke, K.; Ohta, S.; Hatakeyama, T.; Sakaki, S.; Yanagihara, N.
No Shinkei Geka. Neurological Surgery 23(10): 889-895
1995
ISSN/ISBN: 0301-2603 PMID: 7477698 Document Number: 446779
We describe the outcomes and complications of 14 patients with paranasal sinus and anterior cranial fossa lesions surgically treated by an extended transbasal approach, originally described by Kawakami, in our department. They were 10 patients with malignant tumors, 2 with benign tumors, and 2 with inflammatory diseases. A bifrontal craniotomy was performed using a high coronal skin incision, and the orbital rim and roof were removed after the dissection of the dura mater from the anterior skull base. Transcranial resection of the tumor was performed, and assisted by transnasal and transmaxillar resection using a nasal endoscope. Reconstruction of the anterior skull base was performed with the fascia lata and galeopericranial flap in all cases, temporal musculo-pericranial flap in 3 and free bone flap from the cranial convex in 3. Among 10 patients with malignant tumors (malignant melanoma; 4, squamous cell carcinoma; 2, adenocarcinoma; 1, malignant pleomorphic adenoma; 1, chondrosarcoma; 1, and neuroblastoma; 1), total removal was performed in 5 patients and subtotal removal in 5 patients. Though local recurrence of the tumor was recognized in 6 patients, only one underwent additional surgery. Eight patients survived, and 2 patients died of systemic metastasis of the tumor and complications due to liquorrhea. Seven patients obtained a good quality of life, and the mean survival period in 8 patients still living was n months after the first surgery. In 2 patients with benign tumors (chordoma and osteoma), partial and total removal was performed. The patient with chordoma was operated on several times by this approach and the transoral approach, respectively. Each had a good postoperative course. In 2 patients with inflammatory diseases (brain abscess with frontal sinusitis and aspergillosis), total removal was performed. The patient with the brain abscess returned to his former position, but the other developed an epidural abscess and needed reoperation. Postoperative complications were liquorrhea in a patient with squamous cell carcinoma who received irradiation and chemotherapy before combined transbasal and transfacial approach, and an epidural abscess in a patient with aspergillosis complicated by diabetes mellitus. In both patients, the skull base was reconstructed with fascia lata and a galeopericranial flap. The wound healing process in both of these patients was poor. The surgical goal for malignant tumors in the anterior skull base seemed to be to prolong the patient's survival time with good quality of life, and the surgical results for benign lesions in this region were satisfactory. Reconstruction of the anterior skull base using fascia lata and a galeopericranial flap obtained good results, except in cases where the healing process was poor.