Surgery of the anterior skull base: total ethmoidectomy for malignant ethmoidal tumors

The authors report their 17-year experience of total ethmoidectomy using a combined rhinological and neurosurgical approach. As a result of new imaging methods significant progress has been made in the field of pre-operative topographic diagnosis as well as in the operative procedure itself. The optimal skull base reconstruction, which consists of epicranial graft and cryopreserved bone homograft, seems to reduce operative morbidity and mortality. The combined approach technique is shown to be successful in the treatment of both adenocarcinomas and olfactory bulb tumors. However, epidermoid carcinomas still have a poor prognosis due to frequent local recurrences and visceral metastases.