Objectives: The purpose of this work was to examine the indications for the combined transfacial and neurosurgical approach to ethmoid cancers.
Patients and methods: Fifteen patients with ethmoid cancers underwent surgery via the combined approach between 1990 and 2000 at the Amiens University Hospital. The transfacial approach alone was reserved for elderly patients.
Results: The histological diagnosis was adenocarcinoma in 10 patients. There was one postoperative death. Mean follow-up was 45 months (range 3 - 129). Six patients died from local or metastatic recurrence. At last follow-up eight patients were disease free, two had local or metastatic recurrence.
Conclusion: We compared systematic use of the combined approach for curative surgery with surgical strategies adopted by other teams. The combined approach is indicated for T3 or T4 tumors and for all other tumors with a posterior or superior extension. Anterior and unilateral tumors may be treated with the transfacial access alone. Limited tumors without extension to the orbit or cribiform plate may be managed endoscopically. The role of histological diagnosis and the choice of the surgical approach remain to be evaluated.