J Neurol Surg B Skull Base 2014; 75 - a001
DOI: 10.1055/s-0034-1383907

From Craniofacial Resection to Endonasal Endoscopic Removal of Malignant Tumors of the Anterior Skull Base

Boris Krischek 1, F. G. C. Carvalho 2, B. L. G. Godoy 2, R. K. Kiehl 3, G. Z. Zadeh 2, F. G. Gentili 2
  • 1University Hospital of Cologne, Germany
  • 2Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
  • 3Department of Neuropathology, University Health Network, Toronto, Canada

Objective: In addition to the traditional open craniofacial resection (CFR) used for anterior skull base tumors; recently a more minimally invasive pure endonasal endoscopic approach (EEA) for treatment of these lesions has become more widely used and gained acceptance. In this article, we reviewed our indications and limitations of these techniques concentrating primarily on malignant lesions. Patients: Based on our experience over the last three decades we examined our current practice in dealing with tumors and other lesions involving the skull base and performed a retrospective chart analysis. Results: Overall 30 cases were identified, 16 were operated on by CFR, 9 by EEA, and 5 using an endoscopic procedure in combination with a frontal craniotomy. Gross-total resection (GTR) was achieved in 83.3% in the CFR group, and 75% in the EEA group, respectively. Near-total resection was achieved 10% in CFR and 33.3% in EEA group, respectively. Overall 80% had GTR and 20% had near-total resection in the combined group. Conclusion: CFR as well as EEA offer their own advantages and disadvantages. Both can achieve good results with appropriate patient selection. There are several factors, including orbital involvement, dural and brain infiltration, which should be taken in consideration when considering either approach. The most important determinant of outcome is the extent of tumor, location, and histology and the presence of free margins rather than the type of approach used.