Craniofacial Resection: Evolution of the Technique, Mansoura Experience

Surgical resection of the anterior cranial base is commonly indicated for patients with sinonasal tumors involving the cribriform plate or fovea ethmoidalis. This is done, by definition, for most cases of esthesioneuroblastoma, as well as carcinoma of the ethmoid or maxillary sinuses approaching or involving the anterior cranial base. Tumors transgress the cribriform plate either by direct bony invasion or perineural spread along the filaments of the olfactory nerves. The dura of the anterior cranial fossa forms a barrier that delays, to a certain extent, brain invasion. Dural resection in patients with intracranial but extradural disease or patients with limited dural involvement often provides an adequate oncologic margin. In contrast, malignant tumors that transgress the dural barrier and involve the underlying brain parenchyma are usually associated with poor prognosis. In this article, we present our experience in Mansoura University in 50 craniofacial resections for various sinonasal tumors involving the anterior cranial base, from April, 1998 to April, 2011. Overall 35 classical craniofacial resections were done by combined transcranial transfacial approach, 15 cases with modified subcranial craniofacial approach, and 10 cases with endoscopic craniofacial resection. We will discuss the indications, limitations, and complications of each approach as well as the reconstructive modalities.