Anterior craniofacial (transcranial) resection for tumors of nose and paranasal sinuses:Surgical technique

Abstract

Background: Management of nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Anterior craniofacial resection is recognized as the best treatment for nose and paranasal sinus, tumors involving the cribriform plate with or without invasion of anterior cranial fossa. Craniofacial resection allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. Methods: Twenty-one patients underwent anterior craniofacial resection for nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa at Himalayan Institute of Medical Sciences, Dehradun between 2000 and 2011 by a team of head-neck surgeons and neurosurgeons. Results: The series included 16 malignant tumors of the nose and paranasal sinuses and five extensive benign lesions. The mean age was 47.4 years (range, 12 to 68 years). There were 16 men and five women (M:F- 3.2:1.0). Four patients had a recurrence after previous treatments (surgery and/or radiotherapy). The histological subdivision was as follows: Seven cases of squamous cell carcinoma, four cases of adenocarcinoma, three cases of esthesioneuroblastoma, and two cases of undifferentiated tumors. All tumors were resected by a combined bifrontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of CSF-leakage or meningitis, two patients had wound infection. Recurrent tumor growth or systemic metastasis occurred in three (18.75%) out of 16 patients with malignant tumors, 6 months to 2 years postoperatively. The mean follow-up was 16 months. Conclusion: An anterior craniofacial resection should be performed in cases of nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa.