The radical transbasal approach for resection of anterior and midline skull base lesions

Iman Feiz-Erfan, Patrick P. Han, Robert F. Spetzler, Eric Horn, Jeffrey D. Klopfenstein, Randall W. Porter, Mauro A T Ferreira, Stephen P. Beals, Salvatore C. Lettieri, Edward F. Joganic

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Object. Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. Methods. Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1%) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8% (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4% of patients improved or remained the same. Conclusions. The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.

Original languageEnglish (US)
Pages (from-to)485-490
Number of pages6
JournalJournal of Neurosurgery
Volume103
Issue number3
DOIs
StatePublished - Sep 2005
Externally publishedYes

Fingerprint

Skull Base
Maxillary Sinus
Ethmoid Sinus
Posterior Cranial Fossa
Karnofsky Performance Status
Nasopharynx
Mortality
Craniotomy
Nasal Cavity
Orbit
Osteotomy
Scalp
Neoplasms
Morbidity
Therapeutics

Keywords

  • Anterior fossa
  • Craniofacial surgery
  • Sinonasal cavity
  • Transfrontonasoorbital approach

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Feiz-Erfan, I., Han, P. P., Spetzler, R. F., Horn, E., Klopfenstein, J. D., Porter, R. W., ... Joganic, E. F. (2005). The radical transbasal approach for resection of anterior and midline skull base lesions. Journal of Neurosurgery, 103(3), 485-490. https://doi.org/10.3171/jns.2005.103.3.0485

The radical transbasal approach for resection of anterior and midline skull base lesions. / Feiz-Erfan, Iman; Han, Patrick P.; Spetzler, Robert F.; Horn, Eric; Klopfenstein, Jeffrey D.; Porter, Randall W.; Ferreira, Mauro A T; Beals, Stephen P.; Lettieri, Salvatore C.; Joganic, Edward F.

In: Journal of Neurosurgery, Vol. 103, No. 3, 09.2005, p. 485-490.

Research output: Contribution to journalArticle

Feiz-Erfan, I, Han, PP, Spetzler, RF, Horn, E, Klopfenstein, JD, Porter, RW, Ferreira, MAT, Beals, SP, Lettieri, SC & Joganic, EF 2005, 'The radical transbasal approach for resection of anterior and midline skull base lesions', Journal of Neurosurgery, vol. 103, no. 3, pp. 485-490. https://doi.org/10.3171/jns.2005.103.3.0485
Feiz-Erfan I, Han PP, Spetzler RF, Horn E, Klopfenstein JD, Porter RW et al. The radical transbasal approach for resection of anterior and midline skull base lesions. Journal of Neurosurgery. 2005 Sep;103(3):485-490. https://doi.org/10.3171/jns.2005.103.3.0485
Feiz-Erfan, Iman ; Han, Patrick P. ; Spetzler, Robert F. ; Horn, Eric ; Klopfenstein, Jeffrey D. ; Porter, Randall W. ; Ferreira, Mauro A T ; Beals, Stephen P. ; Lettieri, Salvatore C. ; Joganic, Edward F. / The radical transbasal approach for resection of anterior and midline skull base lesions. In: Journal of Neurosurgery. 2005 ; Vol. 103, No. 3. pp. 485-490.
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abstract = "Object. Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. Methods. Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1{\%}) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8{\%} (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4{\%} of patients improved or remained the same. Conclusions. The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.",
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AU - Feiz-Erfan, Iman

AU - Han, Patrick P.

AU - Spetzler, Robert F.

AU - Horn, Eric

AU - Klopfenstein, Jeffrey D.

AU - Porter, Randall W.

AU - Ferreira, Mauro A T

AU - Beals, Stephen P.

AU - Lettieri, Salvatore C.

AU - Joganic, Edward F.

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N2 - Object. Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. Methods. Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1%) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8% (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4% of patients improved or remained the same. Conclusions. The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.

AB - Object. Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach. The radical transbasal approach consists of a bifrontal craniotomy and a frontoorbitonasal osteotomy. Methods. Between 1992 and 2002, 41 patients (28 male and 13 female patients with a mean age of 38.3 years [range 7-77 years]) underwent 44 radical transbasal procedures. Twenty-three malignant and 18 benign lesions involving the midline skull base were treated. These cases were reviewed retrospectively. Gross-total resection of 30 lesions was achieved. Seven lesions were resected subtotally and six partially; one lesion was debulked. Complications occurred in 26 (59.1%) of the 44 operations and mostly consisted of cerebrospinal fluid leakage. The surgery-related mortality rate was 6.8% (three patients). Based on their pre- and postoperative Karnofsky Performance Scale scores, 86.4% of patients improved or remained the same. Conclusions. The radical transbasal approach increases the midline craniofacial corridor by allowing the globes to be safely retracted laterally. It also enhances exposure of the maxillary sinus from above. The morbidity and mortality rates associated with this procedure are high but consistent with the known rates for craniofacial surgery. This approach is best suited for the treatment of anterior skull base tumors that extend into the nasal cavity, orbit, ethmoid sinus, nasopharynx, and upper clivus. The approach may allow resection of tumors involving the maxillary sinus area without the need for an additional transfacial approach.

KW - Anterior fossa

KW - Craniofacial surgery

KW - Sinonasal cavity

KW - Transfrontonasoorbital approach

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