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Advances in surgical management of malignancies of the cranial base: the extended transbasal approach

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Abstract

The extended transbasal approach combines a bifrontal craniotomy with an orbital nasal and potentially a sphenoethmoidal osteotomy to provide excellent access to malignancies of the anterior, middle and posterior skull base. The approach enables the en bloc resection of tumors within the frontal lobes, orbits, paranasal sinuses and sphenoclival corridors without brain retraction and may obviate the need for transfacial access. We present our 7-year experience during which 29 patients underwent surgery with the extended transbasal exposure. In 25 patients the extended transbasal approach was used alone; in the remaining four it was combined with additional approaches. With exception of two patients, all lesions were removed en bloc. Reconstruction was accomplished with the use of pericranium and in some instances a temporalis muscle pedicle or a gracilis microvascular free flap. There were no mortalities associated with this approach. Seven patients experienced infections, four patients experienced cerebral spinal fluid (CSF) leakage, two patients who had received adjuvant radiation experienced scalp necrosis, three patients experienced pneumocephalus, and 29 patients experienced cranial neuropathies, the majority of which were loss of olfaction. The average follow-up for our patients was 34 months with a range of 2–62 months.

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References

  1. JB Blacklock RS Weber YY Lee H Goepfert (1989) ArticleTitleTranscranial resection of tumors of the paranasal sinuses and nasal cavity J Neurosurg 71 IssueID1 10–15 Occurrence Handle1:STN:280:BiaB1MzitVE%3D Occurrence Handle2738628

    CAS  PubMed  Google Scholar 

  2. IT Jackson WR Marsh TA Hide (1984) ArticleTitleTreatment of tumors involving the anterior cranial fossa Head Neck Surg. 6 IssueID5 901–913 Occurrence Handle1:STN:280:BiuB3M7mvFU%3D Occurrence Handle6724957

    CAS  PubMed  Google Scholar 

  3. IT Jackson WR. Marsh U Bite TA Hide (1986) ArticleTitleCraniofacial osteotomies to facilitate skull base tumour resection Br J Plast Surg 39 IssueID2 153–160 Occurrence Handle10.1016/0007-1226(86)90074-3 Occurrence Handle1:STN:280:BimC1cfkt1E%3D Occurrence Handle3697557

    Article  CAS  PubMed  Google Scholar 

  4. AS Ketcham RC Hoye JM Van Buren RH Johnson RR Smith (1966) ArticleTitleComplications of intracranial facial resection for tumors of the paranasal sinuses Am J Surg 112 IssueID4 591–596 Occurrence Handle10.1016/0002-9610(66)90327-8 Occurrence Handle1:STN:280:CCiD3cbhvFc%3D Occurrence Handle5915306

    Article  CAS  PubMed  Google Scholar 

  5. N Sundaresan JP Shah (1988) ArticleTitleCraniofacial resection for anterior skull base tumors Head Neck Surg 10 IssueID4 219–224 Occurrence Handle1:STN:280:BiaC2szpsVw%3D Occurrence Handle3235351

    CAS  PubMed  Google Scholar 

  6. D Uttley A Moore DJ Archer (1989) ArticleTitleSurgical management of midline skull-base tumors: a new approach J NeuroSurg 71 IssueID5 Pt 1 705–710 Occurrence Handle1:STN:280:By%2BD3sblt1M%3D Occurrence Handle2809724

    CAS  PubMed  Google Scholar 

  7. JM Buren ParticleVan AK Ommaya AS Ketcham (1968) ArticleTitleTen years’ experience with radical combined craniofacial resection of malignant tumors of the paranasal sinuses J NeuroSurg 28 IssueID4 341–350 Occurrence Handle5643926

    PubMed  Google Scholar 

  8. M Alaywan M. Sindou (1990) ArticleTitle(1990). Fronto-temporal approach with orbito-zygomatic removal. Surgical anatomy Acta Neurochir 104 IssueID3–4 79–83 Occurrence Handle1:STN:280:By6D28fmt1U%3D

    CAS  Google Scholar 

  9. O Al-Mefty (1987) ArticleTitleSupraorbital-pterional approach to skull base lesions NeuroSurg 21 IssueID4 474–477 Occurrence Handle1:STN:280:BieD28njt1c%3D

    CAS  Google Scholar 

  10. D Banerji S Behari I Tyagi T Pandey VK Jain DK Chhabra (2001) ArticleTitleExtended frontobasal approach to the skull base Neurol India 49 IssueID3 253–261 Occurrence Handle1:STN:280:DC%2BD3Mrks1alsw%3D%3D Occurrence Handle11593242

    CAS  PubMed  Google Scholar 

  11. FJ Carillo RB Leon AM Celis et al. (2004) ArticleTitleAnterolateral and lateral skull-based approaches for treatment of neoplastic diseases Am J Otolaryngol 25 57–58

    Google Scholar 

  12. EW Cocke SuffixJr JH Robertson JT Robertson JP Crook SuffixJr (1990) ArticleTitleThe extended maxillotomy and subtotal maxillectomy for excision of skull base tumors Arch Otolaryngol – Head Neck Surg 116 IssueID1 92–104 Occurrence Handle2294948

    PubMed  Google Scholar 

  13. P Derome M Akerman L Anquez et al. (1972) ArticleTitleLes Tumeurs Spheno-Ethmoldales. Possibilities de réparation chirurgicales Neurochirurgie (Suppl). 18 1–164 Occurrence Handle4630060

    PubMed  Google Scholar 

  14. JA Jane TS Park LH Pobereskin HR Winn AB Butler (1982) ArticleTitleThe supraorbital approach: technical note NeuroSurg 11 IssueID4 537–542 Occurrence Handle1:STN:280:BiyD28zitl0%3D

    CAS  Google Scholar 

  15. K Kawakami Y Yamanouchi C Kubota Y Kawamura H Matsumura (1991) ArticleTitleAn extensive transbasal approach to frontal skull-base tumors. Technical note J NeuroSurg 74 IssueID6 1011–1013 Occurrence Handle1:STN:280:By6B3sjktFA%3D Occurrence Handle2033437

    CAS  PubMed  Google Scholar 

  16. JA Persing JA Jane PA Levine RW Cantrell (1990) ArticleTitleThe versatile frontal sinus approach to the floor of the anterior cranial fossa. Technical note J NeuroSurg 72 IssueID3 513–516 Occurrence Handle1:STN:280:By%2BC2MrkslM%3D Occurrence Handle2303888

    CAS  PubMed  Google Scholar 

  17. J Raveh K Laedrach M Speiser J Chen T Vuillemin R Seiler U Ebeling K Leibinger (1993) ArticleTitleThe subcranial approach for fronto-orbital and anteroposterior skull-base tumors Arch Otolaryngol – Head Neck Surg 119 IssueID4 385–393 Occurrence Handle1:STN:280:ByyB3cjntVY%3D Occurrence Handle8457302

    CAS  PubMed  Google Scholar 

  18. J Raveh JB Turk K Ladrach R Seiler N Godoy J Chen J Paladino M Virag K Leibinger (1995) ArticleTitleExtended anterior subcranial approach for skull base tumors: long-term results J NeuroSurg 82 IssueID6 1002–1010 Occurrence Handle1:STN:280:ByqB1c%2FhtlU%3D Occurrence Handle7760173

    CAS  PubMed  Google Scholar 

  19. VL Schramm SuffixJr EN Myers JC Maroon (1979) ArticleTitleAnterior skull base surgery for benign and malignant disease Laryngoscope 89 IssueID7 Pt 1 1077–1091 Occurrence Handle449551

    PubMed  Google Scholar 

  20. LN Sekhar IP Janecka NF Jones (1988) ArticleTitleSubtemporal-infratemporal and basal subfrontal approach to extensive cranial base tumours Acta Neurochir 92 IssueID1–4 83–92 Occurrence Handle10.1007/BF01401977 Occurrence Handle1:STN:280:BieA3cnps1M%3D

    Article  CAS  Google Scholar 

  21. LN Sekhar A Nanda CN Sen CN Snyderman IP Janecka (1992) ArticleTitleThe extended frontal approach to tumors of the anterior, middle, and posterior skull base J NeuroSurg 76 IssueID2 198–206 Occurrence Handle1:STN:280:By2C3MzmsVM%3D Occurrence Handle1730948

    CAS  PubMed  Google Scholar 

  22. RF Spetzler CT Pappas (1991) ArticleTitleManagement of anterior skull base tumors Clin NeuroSurg 37 490–501 Occurrence Handle1:STN:280:By6C1czns1Y%3D Occurrence Handle2009703

    CAS  PubMed  Google Scholar 

  23. RF Spetzler JM Herman S Beals E Joganic J Milligan (1993) ArticleTitlePreservation of olfaction in anterior craniofacial approaches J NeuroSurg 79 IssueID1 48–52 Occurrence Handle1:STN:280:ByyA3c7ntFU%3D Occurrence Handle8391070

    CAS  PubMed  Google Scholar 

  24. S Honeybul D Neil-Dwyer DA Lang BT Evans (2001) ArticleTitleExtended transbasal approach with preservation of olfaction: an anatomical study Br J Oral Maxillofac Surg 39 IssueID2 149–157 Occurrence Handle10.1054/bjom.2000.0601 Occurrence Handle1:STN:280:DC%2BD3M3gtVajtQ%3D%3D Occurrence Handle11286452

    Article  CAS  PubMed  Google Scholar 

  25. SM Sukkar JA Daw JP Chandler GA Dumanian (2001) ArticleTitleGracilis muscle free flap transfer using a radial artery/venae comitantes composite vascular pedicle Plast Reconstr Surg 108 156–161 Occurrence Handle10.1097/00006534-200107000-00025 Occurrence Handle1:STN:280:DC%2BD3MzlvFyqsQ%3D%3D Occurrence Handle11420519

    Article  CAS  PubMed  Google Scholar 

  26. CH Frazier (1913) ArticleTitleAn approach to the hypophysis through the anterior cranial fossa Annals Surg 57 145–150

    Google Scholar 

  27. SK Gupta VK Khosla BS Sharma (2000) ArticleTitleBilateral fronto-orbito-zygomatic craniotomy – a combined extended frontal and orbitozygomatic approach Neurol India 48 IssueID4 361–364 Occurrence Handle1:STN:280:DC%2BD3M7hslKisQ%3D%3D Occurrence Handle11146602

    CAS  PubMed  Google Scholar 

  28. A Hakuba SS Liu S Nishimura (1986) ArticleTitleThe orbitozygomatic infratemporal approach: a new surgical technique Surg Neurol 26 IssueID3 271–276 Occurrence Handle10.1016/0090-3019(86)90161-8 Occurrence Handle1:STN:280:BimB1cbovVA%3D Occurrence Handle3738722

    Article  CAS  PubMed  Google Scholar 

  29. NF Jones VL Schramm LN Sekhar (1987) ArticleTitleReconstruction of the cranial base following tumour resection Br J Plast Surg 40 IssueID2 155–162 Occurrence Handle10.1016/0007-1226(87)90188-3 Occurrence Handle1:STN:280:BiiC1cngt1E%3D Occurrence Handle3032319

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine and Center for Cranial Base Surgery, 233 E. Erie St., Suite 614, Chicago, 60611, Illinois, USA

    James P. Chandler

  2. Department of Head Neck Oncology and Otolaryngology, Northwestern Memorial Hospital, USA

    Harold J. Pelzer

  3. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Bernard B. Bendok, H. Hunt Batjer & Sean A. Salehi

Authors
  1. James P. Chandler
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  2. Harold J. Pelzer
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  3. Bernard B. Bendok
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  4. H. Hunt Batjer
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  5. Sean A. Salehi
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Correspondence to James P. Chandler.

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Chandler, J.P., Pelzer, H.J., Bendok, B.B. et al. Advances in surgical management of malignancies of the cranial base: the extended transbasal approach. J Neurooncol 73, 145–152 (2005). https://doi.org/10.1007/s11060-004-5173-6

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  • DOI: https://doi.org/10.1007/s11060-004-5173-6

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