Minimizing Morbidity In Anterior/ Antero-lateral Skull Base Surgery
SKULL BASE TUMORS: Complex Anatomy, Varied Pathology, Advanced Presentation, Accessibility, Morbidity. CASE : 46 year old female, Clinical features-epistaxis left nose, nasal blockage and watering left eye ~ 6 months and proptosis of left eye ~ 1 month. MRI ~ naso ethmoid mass occupying both ethmoids, L nasal cavity, breaching cribriform plate ,dural breach ? & L eyeball pushed forward and laterally. Bx ( nasal cavity)Esthesioneuroblastoma Hyams`s grade I. Kadish Stage C Esthesioneuroblastoma. Craniofacial resection followed by 60 Gy IMRT. APPROACHES: Smith RR, Klopp CT, Williams JM. Surgical treatment of cancer of the frontal sinus and adjacent areas. Cancer. 1954;7(5):991-994. Ketcham AS, Wilkins RH, Van Buren JM, et ah A combined intracranial approach to the paranasal sinuses. Am J Surg.1963; 106:698-703. Janecka IP, Sen C, Sekhar LN, Arriaga M. Facial translocation: a new approach to the cranial base. Otolaryngol Head Neck Surg 1990;103:413-9. Wei WI, Lam KH, Sham JST. New approach to the nasopharynx: the maxillary swing approach. Head Neck. 1991;13:200-207. Sekhar LN, Nanda A, Sen CH, et al: The extended frontal approach to tumors of the anterior middle and posterior skull base. J Neurosurg. 1992;76:198-206. Raveh J, Laedrach K, Speiser M, et al: The subcranial approach for frontoorbital and anteroposterior skull base tumor. Arch Otolaryngol Head Neck Surg. 1993;119:385-393 Endoscopic Approaches COMPLICATIONS: Frontal branch Facial N. transection, Janecka IP, Sen C, Sekhar LN, Arriaga M. Facial translocation: a new approach to the cranial base. Otolaryngol Head Neck Surg 1990; 103:413-9. Palatal fistula-7/26, five of them subsequently healed, whereas one patient required surgical closure and one had to wear a dental plate. Wei WI, Lam KH, Sham JST. New approach to the nasopharynx: the maxillary swing approach. Head Neck. 1991; 13:200-207.
Azhar Jan Battoo, M.CH Head and Neck Surgical