Abstract
Lesions involving the anterior skull base and sphenoclival region are difficult surgical problems. This paper presents surgical details, pitfalls, avoidances and our experiences in the surgical treatment of lesions of the anterior skull base using neuronavigation. Between 1999 and 2003, 33 patients with pathology of the anterior skull base were operated on via the traditional transbasal and the extended transbasal approach. A passive-marker-based neuronavigation system has been used for intraoperative image guidance since April 2000. The patients consisted of 11 men and 22 women. Their ages ranged from 3 to 76 years, with a mean of 41 years. The lesions for which the approach was used included 9 cerebrospinal fluid (CSF) fistulae and 24 neoplastic lesions including meningioma (16 cases), metastasis (3 cases), chordoma (3 cases), plasmacytoma (1 case), and osteoma (1 case). Gross total removal of the tumors was accomplished in 22 out of 24 patients with tumor (91.6%). Postoperative complications include CSF leakage (2 cases), infection (2 cases) and transient impaired vision (1 case). One patient (3%) died postoperatively from hypothalamic dysfunction after removal of a benign tumor extending to the anterior third ventricle. Despite the incidence of postoperative infection and the high rate of CSF leakage and death, it is possible to obtain long-term survival for patients with tumors previously considered challenging and difficult surgical problems.
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Banerji D, Behari S, Tyagi I, Pandey T, Jain VK, Chhabra DK (2001) Extended frontobasal approach to the skull base. Neurol India 49:253–261
Derome P, Akerman M, Anquez L et al (1972) Les tumeurs spheno-ethmoidales. Possibilités d’exérése et de réparation chirurgicales. Neurochirurgie [Suppl] 18:1–164
Deschler DG, Gutin PH, Mamelak AN, McDermott MW, Kaplan MJ (1996) Complications of anterior skull base surgery. Skull Base Surg 6:113–118
Donald PJ (1994) Frontobasal approach for trauma and tumor. Minim Invasive Neurosurg 37:37–41
Honeybul S, Neil-Dwyer G, Lang A, Evans BT, Weller RO, Gill J (1999) The extended transbasal approach: a quantitative anatomical and histological study. Acta Neurochir 141:251–259
Kawakami K, Yamanouchi Y, Kubota C, Kawamura Y, Matsumura H (1991) An extensive transbasal approach to frontal-base tumors. J Neurosurg 74:1011–1013
Lang DA, Honeybul S, Neil-Dwyer G, Evans BT, Weller RO, Gill J (1999) The extended transbasal approach: clinical applications and complications. Acta Neurochir 141:579–585
Mehdorn HM, Schrader B, Nabavi A, Hempelmann R (2000) Neuronavigation in the region of the skull base. Laryngorhinootologie 79:404–411
Moore CE, Ross DA, Marentette J (1999) Subcranial approach to tumors of the anterior cranial base: analysis of current and traditional surgical techniques. Otolaryngol Head Neck Surg 120:387–390
Raveh J, Laedrach K, Speiser M, Chen J, Vuillemin T, Seiler R, Ebeling U, Leibinger K (1993) The subcranial approach for fronto-orbital and anteroposterior skull-base tumors. Arch Otolaryngol Head Neck Surg 119:385–393
Robinson JR, Golfinos JG, Spetzler RF (1996) Skull base tumors: a critical appraisal and clinical series employing image guidance. Neurosurg Clin N Am 7:297–311
Roux FX, Moussa R, Devaux B, Nataf F, Page P, Laccorreye O, Schwaab G, Brasnu D, Lacau Saint-Guily (1999) Subcranial fronto-orbito-nasal approach for ethmoidal cancers: surgical techniques and results. Surg Neurol 52:501–510
Sanna M, Mazzoni A, Saleh EA, Taibah AK, Russo A (1994) Lateral approaches to the median skull base through the petrous bone: the system of the modified transcochlear approach. J Laryngol Otol 108:1036–1044
Sekhar LN, Nanda A, Sen CN, Synderman CN, Janecka IP (1992) The extended frontal approach to tumors of the anterior, middle, and posterior skull base. J Neurosurg 76:198–206
Sepehrnia A, Knopp U (1999) Preservation of olfactory tract in bifrontal craniotomy for various lesions of the anterior cranial fossa. Neurosurgery 44:113–117
Spetzler RF, Herman JM, Beals S et al (1993) Preservation of olfaction in anterior craniofacial approaches. J Neurosurg 79:48–52
Sure U, Alberti O, Petermeyer M, Becker R, Bertalanffy H (2000) Advanced image-guided skull base surgery. Surg Neurol 53:563–572
Van Dijk JMC, Thomeer TWM (1997) Control of complications in the midfrontobasal approach. Acta Neurochir 139:355–358
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Kurtsoy, A., Menku, A., Tucer, B. et al. Transbasal approaches: surgical details, pitfalls and avoidances. Neurosurg Rev 27, 267–273 (2004). https://doi.org/10.1007/s10143-004-0322-0
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DOI: https://doi.org/10.1007/s10143-004-0322-0