Combined simultaneous multiportal approach (CSMA) via minimally invasive transciliary and endoscopic endonasal approaches for tumors invading both the skull base and the sinonasal area.

Abstract:

BACKGROUND:For a long time, a combined transcranial and transfacial approach was the gold standard in the aspect of surgical management of large tumors with sinonasal and skull base involvement. The extended endoscopic endonasal approach for such pathologies has its advantages, but flaws as well, such as anatomical limitations, more ponderous skull base reconstruction, thus higher risk of postoperative complications. Our primarily used technique for the surgical treatment of these pathologies has been the combination of transfacial and minimally invasive transciliary supraorbital keyhole approaches. With the aim to further minimize invasivity, potential complications and unsatisfactory esthetic outcomes during the surgical treatment of large tumors invading both the sinonasal area and the skull base, the transfacial approach was left behind and the transciliary supraorbital keyhole approach was simultaneously combined with the endoscopic endonasal approach. METHODS:The well-known microscope assisted minimally invasive approach via transciliary supraorbital keyhole craniotomy was combined with the endoscopic endonasal approach. RESULTS:This manuscript involves 6 cases with different histological types of tumors affecting the sinonasal area and the skull base as well. The mean operative time was 3 hours, none of the patients had unexpected intraoperative, or postoperative complications and we could achieve total tumor removal in each case. None of the patients had complaints associated with the surgery during the follow-ups. CONCLUSION:Our combined simultaneous multiportal approach enables total tumor eradication with reduced operative time, and it is associated with low measures of intraoperative and postoperative complications, low mortality rate and excellent cosmetic results.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Fischer-Szatmári T,Fülöp B,Szakács L,Gyura E,Bella Z,Barzó P

doi

10.1016/j.wneu.2020.12.150

subject

Has Abstract

pub_date

2021-01-05 00:00:00

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(20)32717-0

pub_type

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