Endoscopic endonasal surgery for malignancies of the anterior cranial base

World Neurosurg. 2014 Dec;82(6 Suppl):S22-31. doi: 10.1016/j.wneu.2014.07.021.

Abstract

Objective: Data from several centers worldwide have demonstrated that transnasal endoscopic surgery performed with or without a transcranial approach is capable of achieving radical resection of selected sinonasal malignancies. We report our experience with endoscopic management of sinonasal cancers, with emphasis on naso-ethmoidal malignancies encroaching on the anterior skull base.

Methods: Major series reporting results concerning the endoscopic endonasal approach with or without craniectomy for treatment of sinonasal and anterior skull base cancers were reviewed. Preoperative work-up, indications and exclusion criteria, surgical techniques, postoperative management, and adjuvant therapy are reported.

Results: In the 2 largest series analyzed, the most common malignancies were adenocarcinoma (28%), olfactory neuroblastoma (14.5%), and squamous cell carcinoma (13.5%). The 5-year disease-specific survival rate ranged from 81.9%-87%, with no major differences in the mean follow-up time (34.1 months vs. 37 months).

Conclusions: Endoscopic endonasal resection performed with or without a transcranial approach, when properly planned and in expert hands, has an accepted role with precise indications in the surgeon's armamentarium for the treatment of sinonasal and skull base malignancies.

Keywords: Cranio-endoscopic approach; Craniofacial resection; Endoscopic endonasal approach; Sinonasal cancers; Skull base reconstruction; Skull base surgery.

MeSH terms

  • Adult
  • Aged
  • Chemoradiotherapy, Adjuvant
  • Endoscopy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nasal Cavity / surgery*
  • Neurosurgical Procedures / methods*
  • Plastic Surgery Procedures
  • Postoperative Care
  • Skull Base / surgery
  • Skull Base Neoplasms / diagnosis
  • Skull Base Neoplasms / surgery*
  • Survival Analysis
  • Treatment Outcome