From craniofacial resection to endonasal endoscopic removal of malignant tumors of the anterior skull base
| Autor: | Rasmus Kiehl, Felipe G. Carvalho, Bruno Loyola Godoy, Fred Gentili, Gelareh Zadeh, Boris Krischek |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Nose Neoplasms Skull Base Neoplasms Neurosurgical Procedures Institutional approach Young Adult Postoperative Complications Medicine Humans Craniotomy Craniofacial resection Anterior skull base Aged Retrospective Studies Skull Base business.industry Endoscopy Nasopharyngeal Neoplasms Middle Aged Gross Total Resection Endoscopic Procedure Combined Modality Therapy Combined approach Surgery Skull medicine.anatomical_structure Female Neurology (clinical) Nasal Cavity Neoplasm Recurrence Local business |
| Zdroj: | World neurosurgery. 82 |
| ISSN: | 1878-8769 |
| Popis: | Objective To review the current literature and provide our institutional approach and opinion on the indications and limitations of traditional open craniofacial resection (CFR) and a minimally invasive pure endonasal endoscopic approach for anterior skull base tumors concentrating primarily on malignant lesions. Methods Based on 3 decades of experience with both open and more recently endoscopic techniques, we examined our current practice in treating tumors and other lesions involving the skull base and our current indications and limitations in the use of these techniques. We conducted a retrospective chart analysis to see which operative techniques were used for malignant tumors of the anterior skull base in the last 10 years at our institution. Results There were 30 cases identified. Traditional CFR was performed in 16, a pure endoscopic resection was performed in 9, and an endoscopic procedure combined with a frontal craniotomy was performed in 5. Gross total resection was achieved in 83.3% in the CFR group and 75% in the pure endoscopic resection group. Near-total resection was 10% in the CFR group and 33.3% in pure endoscopic resection group. Of the 5 patients who underwent a combined approach, 80% had gross total resection, and 20% had near-total resection. Conclusions Both traditional CFR and the endonasal endoscopic approach offer advantages and disadvantages. Both approaches can achieve good results with appropriate patient selection. Numerous important factors, including location and the extent of tumor, should be taken into consideration when considering either approach. The most important determinant of outcome is the ability to achieve gross total resection with microscopic negative margins rather than the type of approach used. In the future, skull base surgeons will need to be familiar with and capable of offering both techniques to the patient. |
| Databáze: | OpenAIRE |
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