transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005;19:E6.
36McIntyre JB, Perez C, Penta M, Tong L, Truelson J, Batra PS: Patterns of dural involvement in sinonasal tumors: prospective correlation of magnetic resonance imaging and histopathologic findings. Int Forum Allergy Rhinol 2012;2:336–341.
37Kim HJ, Lee TH, Lee HS, Cho KS, Roh HJ: Periorbita: computed tomography and magnetic resonance imaging findings. Am J Rhinol 2006;20:371–374.
38Christianson B, Perez C, Harrow B, Batra PS: Management of the orbit during endoscopic sinonasal tumor surgery: orbit in endoscopic tumor surgery. Int Forum Allergy Rhinol 2015;5:967–973.
39Dmytriw AA, Witterick IJ, Yu E: Endoscopic resection of malignant sinonasal tumours: current trends and imaging workup. OA Minim Invasive Surg 2013;1:1.
40Nishio N, Fujimoto Y, Fujii M, Saito K, Hiramatsu M, Maruo T, et al: Craniofacial resection for T4 maxillary sinus carcinoma: managing cases with involvement of the skull base. Otolaryngol Head Neck Surg 2015;153:231–238.
41Carta F, Kania R, Sauvaget E, Bresson D, George B, Herman P: Endoscopy skull-base resection for ethmoid adenocarcinoma and olfactory neuroblastoma. Rhinology 2011;49:74–79.
42Yu T, Xu Y-K, Li L, Jia F-G, Duan G, Wu Y-K, et al: Esthesioneuroblastoma methods of intracranial extension: CT and MR imaging findings. Neuroradiology 2009;51:841–850.
43Som PM, Lidov M, Brandwein M, Catalano P, Biller HF: Sinonasal esthesioneuroblastoma with intracranial extension: marginal tumor cysts as a diagnostic MR finding. AJNR Am J Neuroradiol 1994;15:1259–1262.
44Dublin AB, Bobinski M: Imaging characteristics of olfactory neuroblastoma (esthesioneuroblastoma). J Neurol Surg B Skull Base 2016;77:1–5.
45Broski SM, Hunt CH, Johnson GB, Subramaniam RM, Peller PJ: The added value of 18F-FDG PET/CT for evaluation of patients with esthesioneuroblastoma. J Nucl Med Off Publ Soc Nucl Med 2012;53:1200–1206.
46Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH: Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 2012;77:713–724.
47Mascarella MA, Tewfik MA, Aldosari M, Sirhan D, Zeitouni A, Di Maio S: A simple scoring system to predict the resectability of skull base meningiomas via an endoscopic endonasal approach. World Neurosurg 2016;91:582–591.e1.
Roberto Maroldi
Deartment of Radiology, University of Brescia
Piazzale Spedali Civili 1
IT–25123 Brescia (Italy)
E-Mail [email protected]
Nicolai P, Bradley PJ (eds): Anterior Skull Base Tumors. Adv Otorhinolaryngol. Basel, Karger, 2020, vol 84, pp 46–55 (DOI: 10.1159/000457924)
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Transnasal Endoscopic Surgery: Surgical Techniques and Complications
Paolo Battaglia Alessia Lambertoni Paolo Castelnuovo
Division of Otorhinolaryngology – Head and Neck Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Abstract
Nowadays, surgeons have a wide armamentarium of surgical approaches available to safely treat sinonasal malignancies, which includes open approaches, with the traditional craniofacial resection (CFR), and endoscopic transnasal techniques. The correct choice depends on the features of the pathology. It is well known that endoscopic approaches have a lower morbidity compared with traditional open techniques, due to a shorter hospitalization, absence of facial incisions, and avoidance of brain retraction. Moreover, endoscopic surgery presents clear technical advantages. For example, magnification of the surgical field allows the surgeon to carefully identify tumor margins, the site of origin, and the anatomical structures involved by the lesion. Nevertheless, a purely endoscopic approach cannot always provide successful resection of the tumor; the patient must be informed about the possibility of switching to a combined cranioendoscopic resection or CRF, depending on the effective extension of the disease evaluated intraoperatively. Despite these advantages, postoperative complications can occur after endoscopic endonasal surgery, as in any surgical intervention; however, complications after these procedures are less severe and less frequent compared with traditional open approaches. The most common complications observed include skull base reconstruction failure, intraoperative vascular lesions, and orbital or central nervous system complications. Thus, endoscopic endonasal resection, when properly planned and performed by experienced surgeons, is an acceptable treatment for well-selected skull base malignancies with long-term outcomes comparable to those achieved with traditional external approaches.
© 2020 S. Karger AG, Basel
Nowadays, the surgeon has a large armamentarium of surgical approaches available to safely treat sinonasal malignancies that includes open approaches, with the traditional craniofacial resection (CFR) [1], as well as endoscopic endonasal techniques. The correct choice depends on the features of the pathology.
Previously, open approaches with “en bloc resection” [2] were the only reasonable way to adequately treat sinonasal malignancies; in recent decades, however, endoscopic techniques have progressively improved, and can currently be considered as a valid and safe surgical method to accomplish a radical resection of many sinonasal neoplasms [3]. The most important concept approved by the scientific community is “tumor disassembling,” which is a surgical strategy of resection that is considered to be as safe as the traditional “en bloc resection,” with the same oncological outcomes.
Table 1. Indications and contraindications of transnasal endoscopic surgery for malignancies of the sinus and skull base
The evolution of endoscopic procedures has been possible, during recent decades, thanks to several factors, including improvements in surgical technique, especially concerning surgical instrumentation development, refined radiological and diagnostic methods to assess patients preoperatively,
