Transglabellar Combated Extended Approach and Reconstruction in Anterior Skull Base Tumors

Background: Tumors of the nose and paranasal sinuses that involve the anterior skull base are a technical challenge from the standpoint of both resection and avoidance complications. The standard approach includes lateral rhnitomy, with or without Weber Ferguson facial approach and traditional bifrontal craniotomy. During the past years, a modified approach to the anterior skull base is implicated in best results and less complications with more effectiveness. Raveh reports the first transglabellar and subcranial approach as a natural offshoot of their experience with frontobasal trauma. Janecka, Sekhar, and Tessier introduced the craniofacial surgery. We report the experience of the transglabellar approach with single bone flap.

Patients and Methods: Combined approach includes transglabellar and lateral rhnitomy approach was performed in five patients in the National Institute of Cancer from Mexico at the Department of Head and Neck surgery and Neurosurgery.

Surgical Technique: Transglabellar/subcranial approach has been done. The incision should be planned in the glabellar furrows or, if appropriate, in the region camouflaged by the bridge of eyeglasses, extended from the lateral nasal bridge to appropriate 3 mm medial to the skin edge of the caruncle, and extended over the supraorbital border until the supraorbital foramen is located. The bone flap is outlined to include the nasal bones and root and a portion of frontal bone, the size of the frontal bone and the amount of the orbital rims included in the flap is determined by the amount of exposure that will be needed. Reconstruction of anterior skull base was done splitting the frontal bone diploe, fixing the internal surface to the defect, and the exterior surface was fixed with miniplates.

Results: A total of five patients with transglabellar/subcranial approaches were presented for malignant disease, including esthesioneuroblastoma, adenocarcinoma, and adenoid cystic carcinoma. The average OR time was 8 hours. The average blood loss was 750 mL. Major complications included tension pneumoencephalous. Cosmetic and functional results were favorable.

Conclusion: Several authors have published experience with the transglabellar/subcranial approach, but the inclusion of nasal root and nasal bone in the craniotomy flap, allows reconstruction of anterior fossa defects in our experience.