Even though anecdotal examples of operative techniques anticipating the concept of anterior craniofacial resection were published in the 1940s (Dandy 1941) and 1950s (Malecki 1959), Ketcham et al. (1963) must be credited with the first results on a group of 19 patients with malignant tumors, most originating from the sinonasal tract, who had received anterior craniofacial resection. This surgical technique can be considered the major innovative procedure among the external approaches of the last four decades, since it has markedly contributed to improving the prognosis of malignant tumors encroaching the anterior skull base. The basic concept of the operation is to obtain additional exposure of the tumor from above and to ensure even superiorly a free margin of resection. This is usually achieved through a coronal incision and a frontal craniotomy, which, accoording to Raveh et al. (1993), is harvested as low as possible to obtain a good view on the anterior skull base without undue retraction of the frontal lobes (Fig. 5.21). A midfacial degloving, a lateral rhinotomy approach, or even in selected cases a transnasal microendoscopic approach (Thaler et al. 1999) is associated to perform the dissection of the inferior part of the surgical specimen.
Whenever the lesion is in close contact with the skull base, but there are no radiologic and intraoperative signs of bony involvement, the procedure can be carried out extradurally and the dissection superiorly includes the cribriform plate and the fovea ethmoida-lis. Those lesions eroding the skull base and possibly infiltrating the dura dictate instead a wide resection of the dura. The ablative part of the operation must be further extended to include a variable amount of brain parenchyma when the lesion is clearly in contact or even infiltrates the frontal lobe(s). Dura defects require multiple-layer duraplasty which can be performed with different autologous and/or homologous materials. An anteriorly-pedicled pericranium flap down-folded and fixed posteriorly to the planum sphe-noidale is commonly used to reinforce the duraplasty and to offer a nicely vascularized barrier, which divides the sinonasal tract from the cranium.
Bolger WE, Keyes AS, Lanza DC (1999) Use of the superior meatus and superior turbinate in the endoscopic approach to the sphenoid sinus. Otolaryngol Head Neck Surg 120:308-313 Casson PR, Bonanno PC, Converse JM (1974) The midfacial degloving procedure. Plast Reconstr Surg 53:102-113 Colmenero C, Martorell V, Colmenero B et al (1991) Temporalis myofascial flap for maxillofacial reconstruction. J Oral Maxillofac Surg 49:1067-1073 Dandy WE (1941) Orbital tumors. Oskar Priest Publications, New York
Draf W (1991) Endonasal micro-endoscopic frontal sinus surgery, the Fulda concept. Op Tech Otolaryngol Head Neck Surg 2:234-240
Draf W, Weber R, Keerl R et al (2000) Endonasal and external micro-endoscopic surgery of the frontal sinus. In: Stamm A, Draf W (eds) Microendoscopic surgery of the paranasal sinuses and the skull base. Springer-Verlag, Berlin Heidelberg New York, pp 257-278 Draf W, Weber R (1993) Endonasal pansinus operation in chronic sinusitis. I: Indication and operation technique. Am J Otolaryngol 14:394-398 Funk GF, Arcuri MR, Frodel JL (1998) Functional dental rehabilitation of massive palatomaxillary defects: cases requiring free tissue transfer and osseointegrated implants. Head Neck 20:38-51
Goffart Y, Jorissen M, Daele J et al (2000) Minimally invasive endoscopic management of malignant sinonasal tumors. Acta Otorhinolaryngol Belg 54:221-232 Gross CW, Gross WE, Becker DG (1995) Modified transnasal endoscopic Lothrop procedure: frontal drillout. Op Tech Otolaryngol Head Neck Surg 6:193-200. Heermann H (1958) Endonasal surgery with the use of the binocular Zeiss operating microscope. Arch Klin Exp Ohren Nasen Kehlkopfheilkd 171:295-297 Ketcham AS, Wilkins RH, van Buren JM et al (1963) A combined intracranial facial approach to the paranasal sinuses. Am J Surg 106:698-703 Malecki J (1959) New trends in frontal sinus surgery. Acta Otolaryngol (Stockh) 50:137-140 Messerklinger W (1972) Technik und Möglichkeiten der
Nasenendoskopie. HNO 20:133-135 Messerklinger W (1978) Endoscopy of the nose. Urban and
Schwarzenberg, Munich Nicolai P, Berlucchi M, Tomenzoli D et al (2003) Endoscopic surgery for juvenile angiofibroma: when and how. Laryngoscope 113:775-782 Orlandi RR, Lanza DC, Bolger WE et al (1999) The forgotten turbinate: the role of the superior turbinate in endoscopic sinus surgery. Am J Rhinol 13:251-259 Raveh J, Leadrach K, Speiter M et al (1993). The subcranial approach for fronto-orbital and anteroposterior skull-base tumors. Arch Otolaryngol Head Neck Surg 119: 385-393 Roger G, Tran Ba Huy P, Froehlich P et al (2002) Exclusively endoscopic removal of juvenile nasopharyngeal angiofibroma: trends and limits. Arch Otolaryngol Head Neck Surg 128:928-935 Roh HJ, Batza PS, Citazdi, MJ et al (2004) Endoscopic resection of sinonasal malignancies: a preliminary report. Am J Rhinol 18:239-248 Schick B, Steigerwald C, el Tahan R et al (2001) The role of endonasal surgery in the management of frontoethmoidal osteomas. Rhinology 39:667-670 Stamm AC, Draf W (2000) Micro-endoscopic surgery of the paranasal sinuses and the skull base. Springer, Berlin Heidelberg New York Stammberger H (1986a) Endoscopic endonasal surgery-concepts in treatment of recurring rhinosinusitis, part I. Anatomic and pathophysiologic considerations. Otolaryngol Head Neck Surg 94:143-147 Stammberger H (1986b) Endoscopic endonasal surgery-concepts in treatment of recurring rhinosinusitis, part II. Surgical technique. Otolaryngol Head Neck Surg 94:147-156 Stammberger H, Anderhuber W, Walch C et al (1999) Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies. Acta Otorhinolaryngol Belg 53:199-205 Thaler ER, Kotapka M, Lanza DC et al (1999) Endoscopically assisted anterior cranial skull base resection of sinonasal tumors. Am J Rhinol 13:303-310 Tomenzoli D, Castelnuovo P, Pagella F et al (2004) Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience on 47 cases. Laryngoscope 114:193-200 Turner GE, Cassisi NJ (1999) Maxillofacial prosthetics. In: Maniglia AJ, Stucker FJ, Stepnick DW (eds) Surgical reconstruction of the face and anterior skull base. Saunders, Philadelphia, pp 245-258 Weber R, Draf W, Kratzsch B et al (2001) Modern concepts of frontal sinus surgery. Laryngoscope 111:137-146 Wigand ME (1981) Transnasal ethmoidectomy under endo-
scopic control. Rhinology 19:7-15 Zins JE, Whitaker LA (1983) Membranous versus endochon-dral bone: implications for craniofacial reconstruction. Plast Reconstr Surg 72:778-784
Was this article helpful?