Surgical Strategy in Midline Tumours of the Anterior Cranial Fossa

Midline tumors of the anterior cranial fossa (ACF) are mostly represented by olfactory groove menigiomas (OGM). There are many different approaches to this complex anatomical area but only a few that allow from the beginning dural implant removal: purely endoscopic transnasal (EA), transcranial/transfrontal sinus (TFA), and combined EA-TFA (CA) approach. Despite the improvement of EA, the optimal treatment strategy for the surgical treatment of OGM is still a matter of debate. The most advocate advantages of the EA are the absence of cerebral retraction and the possibility to resect the dural implant of the tumor, thus reducing its vascularization. On the other hand, it presents several limits: an important sinonasal morbidity, the loss of olfaction as default, increased risk of postoperative CSF leakage (5-10% in referral centers), especially in anteriorly located tumors. Moreover, the EA is contraindicated in case of lateral (above the orbital floor) or anterior extension (posterior wall of frontal sinus), cerebral parenchima involvment, or in case of major nerves or artery encasement. Consequently, only little tumors extended to the tuberculum sellae or planum sphenoidalis could be safely resected through a purely EA. The TFA is performed by a bicoronal incision, creating a craniotomy on the anterior wall of the frontal sinus and drilling the posterior wall of the frontal sinus. It gives direct access to the dural attachment of the tumor and avoids any cerebral retraction. In case of bulky or far posterior tumors, the interhemispheric route is usually very effective. The TFA permits to remove OGM of any dimension, to deal with nerves of vessel encasement, and to respect meningohypophyseal arteries. The incidence of postoperative CSF leakage is minimal since the closure with the galea is of the utmost effectiveness (0% in our experience). In case of sinonasal involvement, a CA is usually preferred

Surgical Strategy in Midline Tumours of the Anterior Cranial Fossa

Midline tumors of the anterior cranial fossa (ACF) are mostly represented by olfactory groove menigiomas (OGM). There are many different approaches to this complex anatomical area but only a few that allow from the beginning dural implant removal: purely endoscopic transnasal (EA), transcranial/transfrontal sinus (TFA), and combined EA-TFA (CA) approach. Despite the improvement of EA, the optimal treatment strategy for the surgical treatment of OGM is still a matter of debate. The most advocate advantages of the EA are the absence of cerebral retraction and the possibility to resect the dural implant of the tumor, thus reducing its vascularization. On the other hand, it presents several limits: an important sinonasal morbidity, the loss of olfaction as default, increased risk of postoperative CSF leakage (5-10% in referral centers), especially in anteriorly located tumors. Moreover, the EA is contraindicated in case of lateral (above the orbital floor) or anterior extension (posterior wall of frontal sinus), cerebral parenchima involvment, or in case of major nerves or artery encasement. Consequently, only little tumors extended to the tuberculum sellae or planum sphenoidalis could be safely resected through a purely EA. The TFA is performed by a bicoronal incision, creating a craniotomy on the anterior wall of the frontal sinus and drilling the posterior wall of the frontal sinus. It gives direct access to the dural attachment of the tumor and avoids any cerebral retraction. In case of bulky or far posterior tumors, the interhemispheric route is usually very effective. The TFA permits to remove OGM of any dimension, to deal with nerves of vessel encasement, and to respect meningohypophyseal arteries. The incidence of postoperative CSF leakage is minimal since the closure with the galea is of the utmost effectiveness (0% in our experience). In case of sinonasal involvement, a CA is usually preferred

Endoscopic endonasal resection of adenoid cystic carcinoma of the sinonasal tract and skull base

Adenoid cystic carcinoma (ACC) is a locally aggressive salivary gland malignancy prone to perineural invasion and local recurrences. In the literature, few data exist to guide treatment when this tumor involves the paranasal sinuses and skull base. We report our experience in the management of sinonasal adenoid cystic carcinoma through an endoscopic endonasal approach

Transorbital endoscopic assisted resection of a superior orbital fissure cavernous haemangioma: a technical case report

Objectives: Superior orbital fissure and orbital apex lesions are challenging to manage, regardless of the approach chosen, due to the potential morbidity. The objectives of this study are to describe an innovative, minimally invasive surgical approach addressing this critical area and to discuss its indications and outcomes. Subject: A young patient presented with visual disturbances (reduction of color discrimination, central scotoma) and mild exophthalmos owing to the presence of a right orbital apex cavernous haemangioma with superior orbital fissure invasion. Methods: The lesion was removed via a minimally invasive, neuronavigated, transorbital superior eyelid endoscopic-assisted approach. Main outcome measures: Technical feasibility and safety, early and late complications, length of hospitalization time and follow-up data were collected and analyzed. Results: The lesion was radically resected minimizing the surgical morbidity and hospitalization time for the patient and with encouraging functional and cosmetic outcomes. No recurrences were observed 1 year after surgery. Conclusions: The endoscopic-assisted transorbital approach should be considered a safe and effective option that can be applied in the treatment of lesions affecting such complex anatomical regions, as it offers excellent visualization of the surgical field, acceptable sequelae and reduced morbidity in relation to the traditional transcranial/transfacial approaches. Further studies and larger case series are needed in order to validate the reproducibility and range of applications of this surgical technique

Sinonasal non-intestinal type adenocarcinoma: a retrospective review of 22 patients

OBJECTIVE: To analyze outcomes and prognostic factors of sinonasal nonsalivary non-intestinal-type adenocarcinoma (n-ITAC.)METHODS: A retrospective review of 22 consecutive patients with n-ITAC was performed.RESULTS: Average follow-up time was 77 months. The 5-year overall survival and disease-specific survival were 95.2%. The 5-year overall survival and disease-specific survival were 100% for pT1, pT2, and pT3 tumors and 83.3% for pT4a and pT4b tumors; 100% for G1 tumors and 87.5% for G3 tumors; and 100% for tumors with negative surgical margin and 50% for tumors with positive surgical margin. Stage, grade, and surgical margins were independent prognostic factors. Adjuvant radiotherapy was performed for high-grade and high-stage tumors.CONCLUSIONS: Surgery followed by radiotherapy has remained a mainstay for management of n-ITAC, and the endoscopic transnasal approach, when correctly planned and indicated, is the surgery of choice. Adjuvant radiotherapy is recommended in cases of high-stage (T3 and T4) and high-grade tumors. n-ITAC is associated with a favorable outcome. High grade, pT4 stage, and positive surgical margins are independent negative prognostic factors

Endoscopic transnasal resection of Eustachian-tube dermoid in a new-born infant

Introduction: Dermoids of the Eustachian tube are rare benign developmental tumours that typically occur in female children. General consensus of classification and nomenclature has still not been reached. The treatment of choice consists of a radical surgical excision. Several approaches have been described and few cases are reported in literature. A gross total resection is now safely achievable through an endoscopic mini-invasive approach. Materials and methods: We have reported a case of dermoid pedicled in the left Eustachian tube and resected with a pure endoscopic transnasal approach. A review of the literature was performed. Case study: The aim of this paper is to present the first case of pure endoscopic transnasal resection in a 4-day-old infant as emergency treatment of Eustachian tube dermoid presenting an acute respiratory failure at birth. Conclusion: The endoscopic transnasal resection is a safe and feasible technique in selected dermoids of the Eustachian tube, when the middle ear is not involved. This approach could be used also in new-born children, decreasing the morbidity of the classic surgical treatment and avoiding the risk of craniofacial alterations

Quality of life following endoscopic endonasal resection of anterior skull base cancers

For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection.The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy.One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p 60 years (difference of 0.21 points between the preoperative and 1-year period, p 0.1) and T classification of disease at presentation (p > 0.05).Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year

Transnasal endoscopic partial maxillectomy: Operative nuances and proposal for a comprehensive classification system based on 1378 cases

Background: Despite the development of functional endoscopic endonasal surgery, there are still areas of the maxillary sinus that remain technically difficult to access using a standard middle meatal antrostomy as well as deep-seated skull base lesions requiring expanded transmaxillary approaches. Methods: All patients who underwent transnasal endoscopic partial maxillectomy (TEPM) in a single institution from 2000 to 2014 were retrospectively reviewed. The TEPM was classified into 5 types according to the anatomic structures progressively removed and to the access provided. Results: The TEPM was performed in 1378 patients for the management of: inflammatory diseases in 513 cases (37%), benign sinonasal tumors in 425 cases (31%), skull base malignancies in 285 cases (21%), and as a corridor to address deep-seated skull base lesions in 155 cases (11%). Conclusion: The TEPM is a stepwise approach offering increasing access that can be tailored to different maxillary, sinonasal, and skull base pathologies with minimal morbidity for patients. \ua9 2016 Wiley Periodicals, Inc. Head Neck 39: 754\u2013766, 2017