ANTERIOR TRANSCRANIAL (CRANIOFACIAL) RESECTION OF TUMORS OF THE PARANASAL SINUSES - SURGICAL TECHNIQUE AND RESULTS

TRANSFACIAL APPROACHES, TRADITIONALLY used for malignant tumors of the paranasal sinuses, provide limited exposure when several sinuses are involved and are unsuitable for tumors that erode through the floor of the anterior cranial fossa. A transcranial approach may aid in the re moval of such lesions, To better understand the risks and benefits of this surgical approach, we reviewed all patients (n = 76) who underwen t a transcranial approach as part of the excision of paranasal sinus l esions between 1984 and 1993 at our institution. The spectrum of disea se included adenocarcinoma (13 patients), squamous cell carcinoma and olfactory neuroblastoma (11 patients each), adenoid cystic carcinoma a nd poorly differentiated forms of carcinoma (6 patients each), melanom a (5 patients), and miscellaneous others (24 patients). Most patients had ethmoid sinus involvement; tumors were also commonly found in the cribriform plate, sphenoid sinus, and nasal fossa. In each patient, a bifrontal craniotomy was performed with extradural dissection to the f loor of the anterior fossa and osteotomies for resection of involved e lements. In 47 patients (62%), disease in the orbit, the anterior nasa l cavity, or the soft tissues of the face required transfacial as well as transcranial resections. Pony defect in the anterior fossa floor w as repaired with a pedicled pericranial flap. Patients with major comp lications included six patients with epipericranial and/or epidural he matomas requiring evacuation, three with transient cerebrospinal fluid leaks, two who developed bifrontal cerebral infarcts, and one who die d soon after surgery. No meningitis was seen. To date, 26 patients (34 %) have died; of those living (mean follow-up, 34 mo), 42 (84%) remain in full remission. The transcranial approach can achieve removal of e rosive, invasive tumors from this area with predictable morbidity and may be considered whenever sinus tumors breach the anterior cranial ba se or extend beyond the reach of conventional transfacial approaches.