Endoscopic nasal and anterior craniotomy resection for malignant nasoethmoid tumors involving the anterior skull base.

OBJECTIVES: The traditional approach to sinonasal tumors involving the skull base has been the anterior craniofacial resection. The first report by Ketcham et al (American Journal of Surgery, 1963;106:698-703) documented their experience with 17 anterior craniofacial resections for malignant tumors of the sinonasal tract. Later experience with this technique at several centers has resulted in the publication of many refinements of technique and further reduction in the morbidity and mortality associated with this procedure. In our hands, endoscopic techniques have allowed us to approach the intranasal aspect of skull base lesions without external incisions and yet still achieve an en bloc resection. The type of lesions suitable for this approach and the associated technical issues are discussed in this article. METHODS: Between 1999 and 2004, 18 patients with malignant nasoethmoid tumors underwent endoscopic nasal and anterior craniotomy resections. The average age of the patients 60.2 years, with a male-to-female distribution of 15 to 3. Mean follow-up period was 25.1 months. RESULTS: Two patients died from postoperative complications, three died from recurrent disease and two from unrelated causes. Eleven patients are free of disease with a mean survival of 19.8 months. CONCLUSIONS: Although we do not consider this approach a replacement for the traditional anterior craniofacial resection, it is an important adjunct in the skull base surgeon's armamentarium.

Endonasal endoscopic duraplasty: our experience.

OBJECTIVE: Endoscopic repair of cerebrospinal fluid (CSF) leaks is a recognized technique. We consider our experience and evaluate the outcomes in patients who underwent endoscopic repair of CSF leaks. METHODS: A retrospective case note review of 135 patients who underwent anterior cranial repairs of CSF leaks between August 1995 and December 2004 at a tertiary referral center. We describe the technical details and outcomes of care by purely endoscopic procedures. RESULTS: Thirteen patients had combined transcranial and endonasal repairs and 122 patients had their repairs using an endoscopic approach only. There were 64 males and 71 females with ages that ranged from 1 to 75 years (mean age 42 years, median age 44 years). The success rate for first attempt only was 93.4%. Eight of the 122 patients (6.6%) needed a second surgical repair. In one patient a bicoronal approach was necessary while in the other cases a revision endoscopic procedure was appropriate. The period of follow-up ranged from 2 months to 9 years (mean 5 years, median 39 months). CONCLUSIONS: Our experience confirmed that endoscopic surgery is an effective and safe method of treatment for most CSF leaks. A variety of different endoscopic techniques allowed CSF leaks to be repaired in almost every site of the anterior skull base with very few exceptions.

Esthesioneuroblastoma: endonasal endoscopic treatment.

OBJECTIVES: To illustrate endoscopic techniques used in the treatment of esthesioneuroblastoma and to advocate this method of management followed by radiation therapy in selected cases. METHODS: A retrospective case series of 10 patients with esthesioneuroblastomas treated between 1999 and 2004 at a tertiary referral center using endonasal techniques. RESULTS: Mean age of patients at presentation was 56.2 years (median 57 years). Seven patients were female and 3 patients were male. Kadish staging at presentation was: A - 3 patients, B - 5 patients, C - 2 patients. Dulguerov stage at presentation was: T1 - 4 patients, T2 - 4 patients, T3 - 2 patients. The period of follow-up ranged from 11 months to 74 months (mean 38.1 months, median 39 months). To date no recurrence has developed in any patient. CONCLUSIONS: Our experience suggests that endoscopic surgery can be an effective method of management. Strict attention to selection criteria, careful surgical techniques, and regular follow-up are key elements for success.