Subcranial fronto-orbito-nasal approach for ethmoidal cancers surgical techniques and results

BACKGROUND The authors report their experience with the subfronto-orbito-nasal approac h (SFON) for the treatment of 30 patients suffering from ethmoidal cancers over the past 3 years. The advantages and pitfalls of this technique are de scribed and compared with other classic approaches. METHODS Among 156 patients suffering from ethmoidal cancers and treated between Jan uary 1984 and January 1998, 30 patients were operated on using the SFON app roach during the past 3 years. There were 27 males and 3 females, ranging i n age from 15 to 77 years. Histologic composition of the lesions was as fol lows: 15 adenocarcinomas, 6 esthesioneuroblastomas, 3 melanomas, 2 epidermo id carcinomas, 1 nondifferentiated carcinoma, 1 neuroendocrine carcinoma, 1 villous carcinoma, and 1 cystic adenoid carcinoma (cylindroma). According to the authors' classification, 7% were T1, 6% T2, 22% T3, 38.5% T4a, and 2 6.5% T4b. All patients were operated on through a SFON approach, followed b y removal of the tumor and reconstruction of the skull base with a pericran ial flap. RESULTS Since the mean follow-up was of short duration (12 months, ranging from 3 t o 29 months), significant carcinologic results could not be obtained. Howev er, a detailed analysis of the surgical procedure was performed. No patient died or had major complications related to the SFON approach. One cerebros pinal fluid (CSF) fistula and four oculomotricity dysfunctions were observe d. Definitive anosmia was reported in all cases. CONCLUSION The advantages of the procedure include a wide exposure of the anterior sku ll base through a limited approach, the possibility of modifying the approa ch according to the size and location of the lesion, total resection of tum ors, simplified skull base reconstruction technique, and reduction of posto perative confusion and hospital stay. (C) 1999 by Elsevier Science Inc.